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IntroductionCurrent surveillance of antibiotic resistance in Neisseria gonorrhoeae(NG) relies heavily on the culture of NG. However, culture of NG is challenging due to demanding nutritional and growth requirements of this micro-organism. As a result, surveillance data are limited to only cultured strains while of >50% of Dutch NG positive patients no NG is cultured (data from Dutch Gonococcal Surveillance Program). In this study we compared results from direct detection of mosaic penAwith detection of cultured strains to investigate feasibility of direct molecular resistance surveillance.MethodsA convenience sample of 106 NG positive samples of which positive NG culture results were available (46 urine, 9 genital swabs, 35 anorectal swabs and 16 oropharyngeal swabs) were collected between 2013–2015. Presence of mosaic penAwas determined by real-time PCR. All positive findings were confirmed with sequencing. MICs on cultured NG were determined using E-tests.ResultsLOD determinations of the in-house mosaic penAPCR in comparison to routine NAAT (using COBAS 4800, Roche Diagnostics) showed that the mosaic penAassay was slightly less sensitive than the commercial NAAT. In samples with very low NG loads, mosaic penAdetection might be false-negative. Of 106 NG positive samples, 11 samples showed the presence of mosaic penA(6 urine, 4 oropharyngeal and 1 anorectal swab).Of these 11 samples, NG isolates were re-cultured from 8 samples and all isolates contained the mosaic penAgene. MIC values for ceftriaxone varied between 0.016 and 0.094 mg/L and thus no reduced susceptibility was observed. Although cross-detection with mosaic penAfrom N. meningitidisis possible, no evidence of this was shown in this study.ConclusionIn conclusion, this study indicates that detection of mosaic penAdirectly from clinical samples is feasible and that results match detection of penAfrom clinical isolates obtained from these samples. Direct detection of antibiotic resistance genes would show an insight in resistance surveillance of strains that are not or cannot be cultured.

IntroductionRetesting Chlamydia trachomatis(CT) treated people after 3–12 months is recommended as it can yield substantial numbers of reinfections. A test-of-cure (TOC) shortly after treatment (within 3 months) is not advisable due to the likelihood of false positive findings leading to overtreatment. Spatial analyses are useful to detect geographical areas of low guideline adherence to inform local testing policies and targeted interventions. The aim was to assess geographical variation in test practices of general practitioners (GPs) in The Netherlands.MethodsRetrospective laboratory data containing CT tests of 48 GPs in 4 municipalities were obtained (2011–2015) from the public laboratory in the south western part of the Netherlands (183 thousand residents). First recorded urogenital positive CT tests of men (n=249; 39.2%) and women (n=386;60.8%)≥16 years between January 2011 and July 2015 were included in the analyses and TOC and retests were outcomes. Logistic regression was used for analyses.ResultsOverall, 8,275 CT tests were performed (positivity 8.4%;n=691);only 0.4% (n=43) from extra genital sites. On a GP level, the number of CT tests varied geographically from 1 to 2421 (p<0.001). A TOC was performed in 19.1% of the CT cases (n=123;13.8% positive). TOC was more often performed in south Maastricht in comparison with the centre of Maastricht (p=0.02,OR 3.0,95% CI 1.23–7.33). A retest was performed in 23% of the CT cases (n=146;10.3% positive). The rate of retests non-significantly varied geographically between 6.3% and 30.2% p=0.33. Patients with a TOC were more likely to have a retest in comparison with cases without a TOC (p=0.02).ConclusionTesting at extra genital sites and the overall proportion of retests was low at GP practices. Almost one out of five CT cases returned within three months, and many (re-)infections were probably missed. Moreover, it seems that there are geographical variations in test practices of GPs. Thus, targeted interventions at the local level are needed to increase CT testing and retesting practices of GPs.

IntroductionLongitudinal cohort studies provide unique insights but preventing drop-out and missing values is challenging. The aim of this study is to describe how to recruit and maximise retention of 400 Chlamydia trachomatis(CT) positive women in FemCure, an ongoing longitudinal multicenter cohort study aiming to recruit (extra)genital CT positive women.MethodsRecruitment took place at 3 STI-clinics (South Limburg, Amsterdam and Rotterdam). Of the invited women 29% joined. They collected vaginal, anorectal and (nurse-taken) oral swabs and completed online questionnaires pre-treatment, 1, 2, 4, 6, 8, 10 and 12 weeks post-treatment. To minimise loss to follow up (ltfu) various reminders were sent, small incentives were given and no show at the 2nd visit were replaced. Logistic regression analyses were used to assess predictors for ltfu (i.e. age, education level, steady partner, ethnicity, previous CT diagnosis, recruitment clinic, and anatomic site of infection). The results include the first 7 months of recruitment.ResultsBy 11-dec-16 143 participants completed fu. Of them, 81% had complete data, 17% (n=24) was ltfu, of which 18 before the 2nd visit. Nine cases had missing data. Of all questionnaires and swabs (n=1144), 12% was completed after a reminder. Multivariate logistic regression showed that education and age were associated with ltfu. Low education was related to more ltfu than higher education (OR=2.8, 95% CI 1.1–6.8). Those aged 23=> were related to more ltfu than those <23 (OR=2.5, 95% CI 1.0–6.4). No other variables were statistically significantly associated, this may change with ongoing recruitment. At the last visit 86% reported to participate again in a similar study (reasons given include helping others/friendliness of the staff) while the others mention time constraints as a barrier. ConclusionThese preliminary results show a retention rate of 81% without missing data. Approaches described, especially combined with committed healthcare providers can be used to motivate participants to complete fu in future longitudinal multicenter studies.