Culture of Non-Genital Sites Increases the Detection of Gonorrhea in Women

Study Objectives: Although gonorrhea may infect the cervix, rectum, or pharynx of women, culturing non-cervical sites is rare outside of sexually transmitted disease (STD) clinics. This study aims to compare rectal and pharyngeal gonorrhea prevalence in adolescent and adult women and to calculate the percentage of cases that would be missed with cervical culture alone. Design: Retrospective review of two laboratory databases. Setting: STD clinic (2006-2007) and urban children's hospital (2003-2007). Participants: Adolescent women (age 14-21, n = 16,039) in the hospital database; adolescent (n = 525) and adult (age > 21) women (n = 1424) in the STD database. Main Outcome Measures: Prevalence of gonorrhea by group and culture source. Results: Cervical plus additional culture was performed in 76% of adult STD, 52% of adolescent STD, and 2% of adolescent hospital samples. Pharyngeal gonorrhea prevalence in the adolescent hospital (3.5%) was similar to adolescent STD (6.8%, P = 0.1) and adult STD (2.5%, P = 0.4) samples. Rectal gonorrhea prevalence in adolescent hospital (2.9%) was lower than adolescent STD (13.4%, P = 0.01) but not adult STD (5.2%, P = 0.6) samples. Pharyngeal gonorrhea occurred in 0.6-3.4% and rectal gonorrhea in 0-2.7% of women with a negative cervical culture. Culturing only the cervix missed 20-40% of adult STD, 14-26% of adolescent STD, and 11% of adolescent hospital infected cases. Conclusions: Pharyngeal gonorrhea is as high in adolescent women from a children's hospital as in adult women from an STD clinic. Without pharyngeal culture, 11-26% of infected adolescent women would be missed. Increased pharyngeal testing may impact the gonorrhea epidemic among adolescent women.