Duration of Persistence of Gonococcal DNA Detected by Ligase Chain Reaction in Men and Women following Recommended Therapy for Uncomplicated Gonorrhea

Neisseria gonorrhoeae infection remains relatively common in the United States, representing a public health challenge. Ligase chain reaction (LCR) is both highly sensitive and specific for the detection of N. gonorrhoeae in urine and patient-obtained vaginal swab specimens. Because of the LCR test's exquisite sensitivity, it may potentially detect DNA from nonviable organisms following effective therapy, leading to false-positive test results and unnecessary additional treatment. The purpose of the present study was to determine the duration that gonococcal DNA is detectable by LCR following therapy for uncomplicated gonococcal infection. One hundred thirty men and women between the ages of 16 and 50 years presenting to a sexually transmitted disease clinic with urogenital gonorrhea were enrolled. After the standard history was taken and a genital examination was done, the patients were asked to submit either a urine specimen (men) or a urine specimen plus a self-obtained vaginal swab specimen (women) for N. gonorrhoeae testing by LCR at the initial visit and each day during the study period. At enrollment, patients were treated with single doses of ofloxacin, cefixime, or ceftriaxone. The median time to a negative urine LCR test result was 1 day for the men (mean, 1.6 ± 0.14 days) and 2 days for the women (mean, 1.7 ± 0.19 days). Among the women the clearance time was significantly longer for vaginal specimens (mean, 2.8 ± 0.30 days) than for urine specimens (mean, 1.7 ± 0.11 days). Irrespective of patient gender and specimen type, gonococcal DNA can be expected to be absent from urogenital specimens within 2 weeks following successful therapy.

淋病奈瑟菌（Neisseria gonorrhoeae）感染在美国仍较为常见，是一项公共卫生挑战。连接酶链反应（Ligase chain reaction, LCR）对尿液及患者自行采集的阴道拭子标本中的淋病奈瑟菌检测兼具高灵敏度与高特异性。由于LCR检测灵敏度极高，其可能在有效治疗后检测到非活菌的DNA，进而导致假阳性检测结果与不必要的额外治疗。本研究旨在明确无并发症淋病奈瑟菌感染接受治疗后，LCR可检测到淋球菌DNA的持续时长。研究共招募130名年龄介于16至50岁的男女患者，这些患者因泌尿生殖道淋病前往性病诊所就诊。在采集标准病史并完成生殖器检查后，要求患者提交尿液标本（男性）或尿液标本加自行采集的阴道拭子标本（女性），用于初始就诊时及研究期间每日的LCR法淋病奈瑟菌检测。入组时，患者接受单剂量氧氟沙星、头孢克肟或头孢曲松治疗。男性尿液LCR检测转阴的中位时间为1天（平均值为1.6±0.14天），女性为2天（平均值为1.7±0.19天）。在女性患者中，阴道标本的病原体DNA清除时间（平均值为2.8±0.30天）显著长于尿液标本（平均值为1.7±0.11天）。无论患者性别与标本类型如何，成功治疗后2周内，泌尿生殖道标本中预计将检测不到淋球菌DNA。