The occurrence of single-site pharyngeal Neisseria gonorrhoeae among female sex workers in the Netherlands

Background: Female sex workers (FSW) have a higher burden of sexually transmitted infections (STI), including Neisseria gonorrhoeae (NG), than the non-sex worker population, mainly due to social vulnerability and work-related factors. This large study evaluated the anatomical site distribution of NG, and specifically the occurrence of single-site pharyngeal NG, among FSW visiting Dutch STI clinics in the Netherlands. Methods: Coded STI clinic consultations from FSW attending any Dutch STI clinic between 2016 and 2021, in which tests were performed on all three anatomical sites, according to the Dutch testing policy for FSW, were included in analyses (n=22,304). To compare the anatomical site distribution of NG among FSW with women in general, 15,494 consultations from women who were tested on three anatomical sites in clinics that performed standard testing at three anatomical sites were used. Descriptive statistics were used to compare the anatomical site distribution of NG and occurrence of single-site pharyngeal NG among FSW and universally tested women. Results: NG was diagnosed among 3.5% (782/22,034) among FSW and 1.7% (271/15,494) among universally tested women (p<0.001). Pharyngeal NG was diagnosed among 2.3% among FSW, versus 0.8% among universally tested women (p<0.001). Single-site pharyngeal NG was diagnosed in 19.9% (156/782) of all NG infections, compared to 14.8% (40/271) of NG infections among universally tested women. Conclusion: The substantial proportion pharyngeal NG and single-site pharyngeal NG among FSW, confirms the relevance of pharyngeal testing among this key population for optimal patient management, also in the context of the potential role of pharyngeal NG in antimicrobial resistance.