Anatomic site distribution of Neisseria gonorrhoeae in men who have sex with men attending a tertiary care hospital in North India

Background and Objectives:Anorectal and pharyngeal infections with Neisseria gonorrhoeae (NG) are common in men who have sex with men (MSM). However, they are often asymptomatic and found in the absence of reported risk behavior and concurrent genital infection. These serve as a hidden reservoir for ongoing transmission and may cause complications. Additionally, they drive the transmission of other sexually transmitted infections (STIs) including HIV and may contribute to the development of antimicrobial resistance. The current study was undertaken to study the anatomic site distribution of gonococcal infection in MSM as limited data are available from India.Materials and Methods:A total of 127 MSM patients attending the STI clinic Dermatology Outpatient Department of AIIMS were included in the study. A duplex polymerase chain reaction (PCR) targeting opa and porA psuedogene targets using in-house primers was standardized and used for testing. In addition, all samples were processed by conventional methods, i.e., microscopy and culture.Results:A total of 26 patients were found to be positive for NG by PCR with a prevalence rate of 20%. The prevalence rate for urethral, rectal, and pharyngeal gonorrhea was 8.7%, 9.4%, and 4.7% respectively. Out of the 26 positives, 15 patients, i.e., 57.7%, had only extragenital infections and none were positive at all three sites. On the other hand, only three patients were culture positive at the urethral site.Discussion:We would have missed approximately 60% of the infections if the testing was restricted to genital sites only.Conclusion:An expanded testing including extragenital sites for screening of gonococcal infection in MSM will have clinical and public health benefits.