What is the role of nucleic acid amplification tests in the workup of gonorrhea?

Updated: Jun 15, 2021
  • Author: Shahab Qureshi, MD, FACP; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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NAATs amplify genetic sequences (DNA or ribonucleic acid [RNA]) from a few copies to millions in a short period of time. One of the key benefits of NAATs is that a wide variety of specimen types may be sampled, including swabs from the endocervix, vagina, urethra (men), and urine (men and women). Variations of this process include ligase chain reaction tests and strand displacement amplification.

These tests are very sensitive; they are also more rapid than culture, more specific than immunoassays, and do not require viable organisms [41] ; however, they are expensive, and results must be interpreted carefully because of false-positive results in certain settings. [42, 43]

NAATs may be of particular use when examination and mucosal swab are difficult (in children or extremely apprehensive patients) and urine specimens are more easily obtained. However, although these tests can be used on eye secretions, their performance is less well validated. In addition, NAATs are not all recommended for rectal and pharyngeal specimens at this time.

Clinicians should be familiar with specimen collection guidelines and performance parameters of the test available at their own hospitals.

NAATs of genital, rectal, conjunctival, and pharyngeal secretions should also be obtained, regardless of presenting symptoms or exposure history, when disseminated gonococcal infection (DGI) is suspected, even if the patient has no localized symptoms at any of those sites.

Pharyngeal gonococcal infections can occur in heterosexual men diagnosed with urethritis. Screening for pharyngeal colonization by N gonorrhoeae and C trachomatis using validated NAATs has been recommended for heterosexual men diagnosed with urethritis. [44]

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