Sexually transmitted infections · 2026
Predictors of positive culture in NAAT-confirmed rectal N. gonorrhoeae infection among men who have sex with men.
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Passini Flavia, Raccagni Angelo Roberto, Lolatto Riccardo, Capra Nicolò, Lucente Maria Francesca, Candela Caterina, Muccini Camilla, Bruzzesi Elena, Negri Marcella, Castagna Antonella, Nozza Silvia
Аннотация
BACKGROUND: Gonorrhoea is a common sexually transmitted infection (STI) among men who have sex with men (MSM). Nucleic acid amplification tests (NAATs) are the recommended diagnostic method; however, the interpretation of positive results in asymptomatic individuals remains uncertain. The aim of this study was to identify factors associated with positive culture results in NAAT-confirmed rectal gonorrhoea.
METHODS: This retrospective study included individuals receiving HIV care, pre-exposure prophylaxis or STI screening at the Infectious Diseases Unit of San Raffaele Hospital, Milan, Italy, between January 2021 and January 2025. Individuals with NAAT-confirmed rectal Neisseria gonorrhoeae who also underwent culture testing were included. Demographic and clinical data were collected. Group comparisons were performed between individuals with positive or negative cultures.
RESULTS: Among 556 individuals with NAAT-confirmed rectal N. gonorrhoeae (552 MSM and 4 women who have sex with men), 200 (35.3%) had a positive culture. The median age was 35.7 years (IQR=30.7-41.9). Individuals with a positive culture were younger (34.9 vs 36.4 years; p=0.013) and more frequently symptomatic (56.5% vs 16.6%; p<0.001), particularly reporting anal burning, gastrointestinal symptoms, tenesmus and anal discharge (all p<0.001).
CONCLUSIONS: Gonococcal culture was positive in about one-third of NAAT-confirmed rectal infections. The presence of STI-related symptoms was associated with a positive culture. These findings corroborate the limited sensitivity of gonococcal culture and may help guide resistance surveillance strategies.
METHODS: This retrospective study included individuals receiving HIV care, pre-exposure prophylaxis or STI screening at the Infectious Diseases Unit of San Raffaele Hospital, Milan, Italy, between January 2021 and January 2025. Individuals with NAAT-confirmed rectal Neisseria gonorrhoeae who also underwent culture testing were included. Demographic and clinical data were collected. Group comparisons were performed between individuals with positive or negative cultures.
RESULTS: Among 556 individuals with NAAT-confirmed rectal N. gonorrhoeae (552 MSM and 4 women who have sex with men), 200 (35.3%) had a positive culture. The median age was 35.7 years (IQR=30.7-41.9). Individuals with a positive culture were younger (34.9 vs 36.4 years; p=0.013) and more frequently symptomatic (56.5% vs 16.6%; p<0.001), particularly reporting anal burning, gastrointestinal symptoms, tenesmus and anal discharge (all p<0.001).
CONCLUSIONS: Gonococcal culture was positive in about one-third of NAAT-confirmed rectal infections. The presence of STI-related symptoms was associated with a positive culture. These findings corroborate the limited sensitivity of gonococcal culture and may help guide resistance surveillance strategies.