Sexual Health Sexual Health Society
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REVIEW

Exploring ‘best practice’ for nucleic acid detection of Neisseria gonorrhoeae

David M. Whiley A B , Suzanne M. Garland C D , Geoffrey Harnett E , Gary Lum F , David W. Smith E , Sepehr N. Tabrizi C D , Theo P. Sloots A B and John W. Tapsall G H
+ Author Affiliations
- Author Affiliations

A Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewski Virus Research Centre, Royal Children’s Hospital and Health Service District, Brisbane, Qld 4029, Australia.

B Clinical Medical Virology Centre, University of Queensland, Qld 4029, Australia.

C Department of Microbiology and Infectious Diseases, The Royal Womens’ Hospital, Melbourne, Vic. 3053, Australia.

D Department of Obstetrics and Gynaecology, University of Melbourne, Vic. 3053, Australia.

E Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine Nedlands, WA 6009, Australia.

F Microbiology Laboratory, Pathology Department, Royal Darwin Hospital, Casuarina, NT 0810, Australia.

G WHO Collaborating Centre for STD and HIV, Microbiology Department, The Prince of Wales Hospital, Randwick, NSW 2031, Australia.

H Corresponding author. Email: j.tapsall@unsw.edu.au

Sexual Health 5(1) 17-23 https://doi.org/10.1071/SH07050
Submitted: 6 July 2007  Accepted: 12 December 2007   Published: 22 February 2008

Abstract

Nucleic acid detection tests (NADT) have considerable benefits for the detection of Neisseria gonorrhoeae (GC), including high sensitivity across a range of specimen types and use under widely differing settings and conditions. However, sexual health practitioners and others who use data generated by NADT for GC should be aware of some important limitations of these tests. False-positive results caused by cross reaction with commensal Neisseria species have been observed in many assays, and have lead to unacceptably low positive-predictive values in some patient populations. Further, false-negative results can be caused by GC sequence variation, with some gonococci lacking certain NADT target sequences. This review examines the issues associated with gonococcal NADT and considers best practice for use of these assays based on current knowledge. We emphasise the need for supplementary testing and extensive assay validation, and suggest appropriate strategies for these requirements irrespective of the setting in which they are used. Further, we highlight the need to maintain culture-based testing for certain specimen sites as well as for antimicrobial resistance surveillance.


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