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The use and performance of oral—throat rinses to detect pharyngeal Neisseria
gonorrhoeae and Chlamydia trachomatis infections.
Diagnostic Microbiology and Infectious Disease 2007; 59:259-264.
Papp JR, Ahrens K, Phillips C, Kent CK,
Philip S, Klausner JD.
Abstract
Gonococcal and chlamydial infections in the pharynx can occur as a consequence
of oral sex. Currently, diagnosis of these infections typically requires a
swab specimen to be collected from the posterior pharynx. However, we assessed
the diagnostic adequacy of using commercial mouthwash or water as an oral-throat
rinse and subsequent testing with a nucleic acid amplification test (Gen-Probe
APTIMA Combo 2 assay; Gen-Probe, San Diego, CA). Mouthwash and water samples,
spiked with varying amounts of gonorrhea and chlamydia, remained positive
for both organisms for up to 2 weeks after storage at room temperature and
37 degrees C. A clinical trial compared the test performance of oral-throat
rinses to pharyngeal swabs among 561 (250 mouthwash, 311 water) gay and other
men who have sex with men. Participants were also surveyed to assess the acceptability,
preference, and feasibility of oral-throat rinses in a clinical setting. The
prevalence of pharyngeal gonorrhea and chlamydia were 9.5% (53/556) and 1.4%
(8/561), respectively. Compared with the pharyngeal swab, mouthwash oral-throat
rinses had a sensitivity and specificity for the detection of gonorrhea of
72% and 99.1%, respectively, whereas water had 82% and 99.7%, respectively.
Chlamydia prevalence was too low for reliable assessments of test performance.
Study participants found oral-throat rinses acceptable, preferable, and feasible
when compared with pharyngeal swabs. Further study is needed to investigate
discordant results and improve the sensitivity of oral-throat rinses.