Increased testing for Neisseria gonorrhoeae with duplex nucleic acid amplification tests in Australia: implications for surveillanceBasil Donovan A B E , Wayne Dimech C , Hammad Ali A , Rebecca Guy A , Margaret Hellard D and on behalf of the ACCESS Collaboration
A Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia.
B Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia.
C National Serology Reference Laboratory, Fitzroy, Vic. 3065, Australia.
D Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
E Corresponding author. Email: firstname.lastname@example.org
Sexual Health 12(1) 48-50 https://doi.org/10.1071/SH14179
Submitted: 5 September 2014 Accepted: 5 December 2014 Published: 9 February 2015
Background: Gonorrhoea notifications have been increasing in Australia’s cities, in both men and women. We investigated if this could be, at least in part, a result of a testing artefact. Methods: We surveyed 28 laboratories that were known to test for both Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) to determine their testing and reporting practices, and when these practices were instituted. Results: By 2012, 23 (82%) of the laboratories were routinely performing duplex nucleic acid amplification tests for both CT and NG even if a test for only one organism was requested, up from 9 (32%) laboratories before 2007. Although written reports of negative NG tests were not provided if the test was not requested, positive NG tests were always communicated to the attending clinician. Conclusions: The move towards routine duplex testing for CT and NG has probably resulted in more Australians being tested for NG than ever before. While this change has advantages for case-finding and improved public health outcomes, it also brings an increasing potential for false-positive NG tests. Recent trends in NG notifications should be interpreted with caution.
References Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2013. Sydney: Kirby Institute, UNSW Australia; 2013.
 NSW Health Protection, Communicable Diseases Branch. Sexually transmitted infections notification data 4th quarterly report 2013. Sydney: NSW Ministry of Health; 2014. Available at: http://www.health.nsw.gov.au/Infectious/reports/Documents/STI-4thQuarter-Report-2013.pdf [Verified 5 August 2014]
 Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. Melbourne: RACGP; 2012.
 Kong FYS, Guy RJ, Hocking JS, Merritt T, Pirotta M, Heal C, et al Australian general practitioner chlamydia testing rates among young people. Med J Aust 2011; 194 249–52.
 Ali H, Guy RJ, Fairley CK, Wand H, Chen MY, Dickson B, et al Understanding trends in genital Chlamydia trachomatis can benefit from enhanced surveillance: findings from Australia. Sex Transm Infect 2012; 88 552–7.
| Understanding trends in genital Chlamydia trachomatis can benefit from enhanced surveillance: findings from Australia.CrossRef | 22645390PubMed |
 Guy R, Kong F, Goller J, Franklin N, Bergeri I, Dimech W, et al A new national chlamydia surveillance system in Australia: evaluation of the first stage of implementation. Commun Dis Intell 2010; 34 319–28.
 Dimech W, Lim MSC, van Gemert C, Guy R, Boyle D, Donovan B, et al Analysis of laboratory testing results collected in an enhanced chlamydia surveillance system in Australia, 2008–2010. BMC Infect Dis 2014; 14 325
| Analysis of laboratory testing results collected in an enhanced chlamydia surveillance system in Australia, 2008–2010.CrossRef | 24920016PubMed |
 Newton DC, McCabe MP. Sexually transmitted infections: impact on individuals and their relationships. J Health Psychol 2008; 13 864–9.
| Sexually transmitted infections: impact on individuals and their relationships.CrossRef | 18809636PubMed |
 Smith DW, Tapsall JW, Lum G. Guidelines for the use and interpretation of nucleic acid detection tests for Neisseria gonorrhoeae in Australia: a position paper on behalf of the Public Health Laboratory Network. Commun Dis Intell 2005; 29 358–65.
 Trembizki E, Lahra M, Stevens K, Freeman K, Hogan T, Hogg G, et al A national quality assurance survey of Neisseria gonorrhoeae testing. J Med Microbiol 2014; 63 45–9.
| A national quality assurance survey of Neisseria gonorrhoeae testing.CrossRef | 24092762PubMed |
 McDonagh P, Ryder N, McNulty AM, Freedman E. Neisseria gonorrhoeae infection in urban Sydney women: prevalence and predictors. Sex Health 2009; 6 241–4.
| Neisseria gonorrhoeae infection in urban Sydney women: prevalence and predictors.CrossRef | 19653962PubMed |
 Bourne C, Allen D, Brown K, Davies SC, McNulty AM, Smith DE, et al What proportion of sexually transmissible infections and HIV are diagnosed in New South Wales’ public sexual health services compared with other services? Sex Health 2013; 10 119–23.
| What proportion of sexually transmissible infections and HIV are diagnosed in New South Wales’ public sexual health services compared with other services?CrossRef | 23448750PubMed |