Comparison of Culture and PCR Methods in the Detection of Neisseria gonorrhoeae in Patients Suspected of Gonorrhea
-
Bahareh Sheikh Eslami
,
Mohammad Hesam Aslani
,
Haniyeh Bashi Zadeh Fakhar
,
Fatemeh Rezaei
,
Shaghyegh Rangraz
Abstract
Background: This study compares the effectiveness of culture and PCR methods in detecting Neisseria gonorrhoeae , a Gram-negative bacterium causing gonorrhea, which can lead to serious health complications, especially in women, and highlights the advantages of nucleic acid amplification tests over traditional culture-based diagnosis.
Methods: This study involved 70 individuals suspected of gonorrhea who referred to Baqiyatallah Hospital in Tehran between September and February 2022, with ethical approval and informed consent obtained from all participants. Two swab samples were collected from each individual—one for culture and one for molecular testing—and stored appropriately for microbiological and genomic analysis.
Results: This study examined 70 women suspected of having gonorrhea, with a mean age of 32.32 ± 8.58 years, and found a prevalence of 30% by vaginal culture and 28.57% by PCR testing. Using PCR as the gold standard, the sensitivity and specificity of culture for diagnosing gonorrhea were determined to be 45% and 76%, respectively.
Conclusion: Of course, the differences could be due to the size of the studied populations, but the important point is the high accuracy and sensitivity of the PCR test in identifying Neisseria gonorrhoeae, which has been mentioned in most studies.
1. Christodoulides, Myron, ed. Neisseria Gonorrhoeae : Methods and Protocols. New York, NY: Humana Press, 2019. Print.
2. Ghanbari F, Bashi Zadeh Fakhar H, Alamian S, et al. Comparative evaluation of serological, elisa and molecular tests in diagnosis of Brucella abortus in human serum. J Med Bacteriol 2023: 11(6);156-62.
3. WHO. Global Progress Report on HIV, Viral Hepatitis and Sexually Transmitted Infections, 2021: Accountability for the Global Health Sector Strategies 2016–2021: Actions for Impact. 2022. https://www. who.int/publications/i/item/9789240027077.
4. Rowley J, Vander Hoorn S, Korenromp E, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019; 97:548-62.
5. World Health Organization (WHO). Global incidence and prevalence of selected curable sexually transmitted infections-2008. Geneva: World Health Organization 2012.
6. Papp JR, Schachter J, Gaydos CA, et al. Centers for Disease Control and Prevention. MMWR: recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae-2014. MMWR Recomm Rep 2014; 63(RR-02):1-19.
7. Hill SA, Masters TL, Wachter J. Gonorrhea—an evolving disease of the new millennium. Microb Cell 2016; 3:371-89.
8. Unemo M, Seifert HS, Hook EW. Gonorrhoea. Nat Rev Dis Primers 2019; 5:79.
9. Suay-García B, Pérez-Gracia MT. Drug-resistant Neisseria gonorrhoeae: latest developments. Eur J Clin Microbiol Infect Dis 2017; 36:1065-71.
10. Lewis DA. Global resistance of Neisseria gonorrhoeae: when theory becomes reality. Curr Opin Infect Dis 2014; 27:62-7.
11. Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev 2014; 27:587-613.
12. Chen L, Shin JD, Zheng SH, et al. Direct-qPCR assay for coupled identification and antimicrobial susceptibility testing of Neisseria gonorrhoeae. ACS Infect Dis. 2018; 4(9):1377-84.
13. Meyer T, Buder S. The laboratory diagnosis of neisseria gonorrhoeae: current testing and future demands. Pathogens 2020; 9(2):91.
14. Murtagh MM. The point-of-care diagnostic landscape for sexually transmitted infections (stis). The Murtagh Group 2017, accessed 20 May 2020):1-63.
15. Abbai NS, Moodley P, Reddy T, et al. Clinical evaluation of the one-step gonorrhea rapicard instatest for detection of Neisseria gonorrhoeae in symptomatic patients from KwaZulu-Natal, South Africa. J Clin Microbiol 2015; 53(4): 1348-50.
16. Dona V, Kasraian S, Lupo A, et al. Multiplex real-time PCR assay with high resolution melting analysis for characterization of antimicrobial resistance in Neisseria gonorrhoeae. J Clin Microbiol 2016:2074-81.
17. Dona V, Low N, Golparian D, et al. Recent advances in the development and use of molecular tests to predict antimicrobial resistance in Neisseria gonorrhoeae. Expert Rev Mol Diagn 2017; 17:845-59.
18. Yamin D, Uskoković V, Wakil AM, et al. Current and future technologies for the detection of antibiotic-resistant bacteria. Diagnostics (Basel) 2023; 13(20):3246.
19. Kirkcaldy RD, Weston E, Segurado AC, et al. Epidemiology of gonorrhoea: a global perspective. Sex. Health 2019, 16:401-11.
20. Firdiana SE, Muslimin M, Farida H. Perbandingan efektifitas seftriakson dengan siprofloksasin pada kuman Neisseria gonorrhoeae secara in vitro. JKD 2016; 5(4):1736-42.
21. Kardjadj M, Chang TW, Chavez R, et al. The clinical validity and utility of pcr compared to conventional culture and sensitivity testing for the management of complicated urinary tract infections in adults: a secondary (ad hoc) analysis of pathogen detection, resistance profiles, and impact on clinical outcomes. Microorganisms 2025; 13(4):949.
22. Abdullahi A, Nzou SM, Kikuvi G, et al. Neisseria gonorrhoeae infection in female sex workers in an STI clinic in Nairobi, Kenya. PLoSOne 2022; 17(2):e0263531.
23. Waseem H, Naeem A, Ali S, et al. Multiplex polymerase chain reaction (PCR) for the detection of Neisseria gonorrhoeae and the quinolone resistance gene in Pakistan. PAFMJ 2021; 71:866-9.
24. Barbee LA, Golden MR, Thibault Ch S, et al. Performance of patient -collected specimens for Neisseria gonorrhoeae culture. Clin Infect Dis 2021; 73(9):125-32.
25. Enitan SS, Imaralu JO, Chioma I, et al. Performance of two diagnostic methods in the detection of gonorrhea among pregnant women in ogun state, Nigeria. Acta Sci Microbiol 2022; 5(9):2252581-32262.
26. Unemo M, Seifert HS, Hook EW, et al. Gonorrhoea. Nat Rev Dis primers 2019;36:1065-71.
27. Hill SA, Masters TL, Wachter J. Gonorrhea evolving disease of the new millennium. Microb cell 2016; 3:361-88.
28. Parsapour H, Alizamir A, Khansary Sh, et al. The frequency of Neisseria gonorrhoeae endocervical infection and its antibiotic resistance pattern in women referred to gynecology clinic of Fatemieh Hospital in Hamadan in 2020. J Obstetrics Gynecol Cancer Res 2022; 28:123-40.
29. Yalew E, Wolde M, Ebrahim S, et al. Prevalence and antimicrobial susceptibility pattern of Neisseria gonorrhoeae from selected public health centers, Addis Ababa, Ethiopia. Res Sq 2022.1-11.
30. Dela H, Attram N, Behene E, et al. Risk factors associated with gonorrhea and Chlamydia transmission in selected health facilities in Ghana. BMC Infect Dis 2019; 19:1-8
31. Mabonga E, Manabe YC, Elbireer A, et al. Prevalence and predictors of asymptomatic Chlamidya trachomatis and Neisseria gonorrhoeae in a Ugandan Population most at risk of HIV transmission. Int J STD AIDS 2021; 32(6):510-16.
32. Chang SX, Chen KK, Liu XT, et al. Cross-sectional study of asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infections in sexually transmitted disease related clinics in Shenzhen, China. PLoSOne 2020; 15(6):e0234261.
33. Khariri, Sariadji K. Penerapan Teknik Laboratorium Sederhana Dengan Pewarnaan Gram Untuk Deteksi Cepat Infeksi Neisseria Gonorrhoeae Pada Wanita Penjaja Seks (WPS). Seminar Nasional Cendekiawan 2018;411-16.
34. Nateghi Rostami M, Hossein Rashidi B, Aghsaghloo F, et al. A multiplex assay of Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae infections in genital specimens. J Infect Dev Countries 2017; 11(11):833839.
35. Syarif S, Hadju L, Putri FA. Perbandingan Deteksi Bakteri Neisseria gonorrhoeae pada Urine PSK menggunakan metode konvensional dan metode PCR (Polymerase Chain Reaction) di Puskesmas Perumnas Kota Kendari. J MediLab Mandala Waluyo 2021; 5(1):17-22
36. Marzony I, Yani FF, Efrida D. Uji Diagnostik C-Reactive Protein pada Pneumonia Bakteri Komunitas Anak. Sari Pediatri 2016; 17(5):391-5.
37. Farooqi L, Amini K. Simultaneous molecular identification of Neisseria gonorrhoeae and Toxoplasma gondii from vaginal swabs of infertile women by multiplex polymerase chain reaction. J AUMS 2021;10(3):297-304
38. Ríos-Castillo AG, Ripolles-Avila C, Rodríguez-Jerez JJ. Detection by real-time PCR and conventional culture of Salmonella typhimurium and Listeria monocytogenes adhered to stainless steel surfaces under dry conditions. Food Control 2022; 137:108971.
39. Boiko I, Stepas Y, Krynytska I. Comparison of deferred and bedside culture of Neisseria gonorrhoeae: a study to improve the isolation of gonococci for antimicrobial susceptibility testing. Iranian J Microbiol 2020; 12(3):216
40. Xiu L, Wang L, Li Y, et al. Multicentre clinical evaluation of a molecular diagnostic assay to identify Neisseria gonorrhoeae infection and detect antimicrobial resistance. Int J Antimicrob Agents 2023; 61(5):106785.
2. Ghanbari F, Bashi Zadeh Fakhar H, Alamian S, et al. Comparative evaluation of serological, elisa and molecular tests in diagnosis of Brucella abortus in human serum. J Med Bacteriol 2023: 11(6);156-62.
3. WHO. Global Progress Report on HIV, Viral Hepatitis and Sexually Transmitted Infections, 2021: Accountability for the Global Health Sector Strategies 2016–2021: Actions for Impact. 2022. https://www. who.int/publications/i/item/9789240027077.
4. Rowley J, Vander Hoorn S, Korenromp E, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019; 97:548-62.
5. World Health Organization (WHO). Global incidence and prevalence of selected curable sexually transmitted infections-2008. Geneva: World Health Organization 2012.
6. Papp JR, Schachter J, Gaydos CA, et al. Centers for Disease Control and Prevention. MMWR: recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae-2014. MMWR Recomm Rep 2014; 63(RR-02):1-19.
7. Hill SA, Masters TL, Wachter J. Gonorrhea—an evolving disease of the new millennium. Microb Cell 2016; 3:371-89.
8. Unemo M, Seifert HS, Hook EW. Gonorrhoea. Nat Rev Dis Primers 2019; 5:79.
9. Suay-García B, Pérez-Gracia MT. Drug-resistant Neisseria gonorrhoeae: latest developments. Eur J Clin Microbiol Infect Dis 2017; 36:1065-71.
10. Lewis DA. Global resistance of Neisseria gonorrhoeae: when theory becomes reality. Curr Opin Infect Dis 2014; 27:62-7.
11. Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev 2014; 27:587-613.
12. Chen L, Shin JD, Zheng SH, et al. Direct-qPCR assay for coupled identification and antimicrobial susceptibility testing of Neisseria gonorrhoeae. ACS Infect Dis. 2018; 4(9):1377-84.
13. Meyer T, Buder S. The laboratory diagnosis of neisseria gonorrhoeae: current testing and future demands. Pathogens 2020; 9(2):91.
14. Murtagh MM. The point-of-care diagnostic landscape for sexually transmitted infections (stis). The Murtagh Group 2017, accessed 20 May 2020):1-63.
15. Abbai NS, Moodley P, Reddy T, et al. Clinical evaluation of the one-step gonorrhea rapicard instatest for detection of Neisseria gonorrhoeae in symptomatic patients from KwaZulu-Natal, South Africa. J Clin Microbiol 2015; 53(4): 1348-50.
16. Dona V, Kasraian S, Lupo A, et al. Multiplex real-time PCR assay with high resolution melting analysis for characterization of antimicrobial resistance in Neisseria gonorrhoeae. J Clin Microbiol 2016:2074-81.
17. Dona V, Low N, Golparian D, et al. Recent advances in the development and use of molecular tests to predict antimicrobial resistance in Neisseria gonorrhoeae. Expert Rev Mol Diagn 2017; 17:845-59.
18. Yamin D, Uskoković V, Wakil AM, et al. Current and future technologies for the detection of antibiotic-resistant bacteria. Diagnostics (Basel) 2023; 13(20):3246.
19. Kirkcaldy RD, Weston E, Segurado AC, et al. Epidemiology of gonorrhoea: a global perspective. Sex. Health 2019, 16:401-11.
20. Firdiana SE, Muslimin M, Farida H. Perbandingan efektifitas seftriakson dengan siprofloksasin pada kuman Neisseria gonorrhoeae secara in vitro. JKD 2016; 5(4):1736-42.
21. Kardjadj M, Chang TW, Chavez R, et al. The clinical validity and utility of pcr compared to conventional culture and sensitivity testing for the management of complicated urinary tract infections in adults: a secondary (ad hoc) analysis of pathogen detection, resistance profiles, and impact on clinical outcomes. Microorganisms 2025; 13(4):949.
22. Abdullahi A, Nzou SM, Kikuvi G, et al. Neisseria gonorrhoeae infection in female sex workers in an STI clinic in Nairobi, Kenya. PLoSOne 2022; 17(2):e0263531.
23. Waseem H, Naeem A, Ali S, et al. Multiplex polymerase chain reaction (PCR) for the detection of Neisseria gonorrhoeae and the quinolone resistance gene in Pakistan. PAFMJ 2021; 71:866-9.
24. Barbee LA, Golden MR, Thibault Ch S, et al. Performance of patient -collected specimens for Neisseria gonorrhoeae culture. Clin Infect Dis 2021; 73(9):125-32.
25. Enitan SS, Imaralu JO, Chioma I, et al. Performance of two diagnostic methods in the detection of gonorrhea among pregnant women in ogun state, Nigeria. Acta Sci Microbiol 2022; 5(9):2252581-32262.
26. Unemo M, Seifert HS, Hook EW, et al. Gonorrhoea. Nat Rev Dis primers 2019;36:1065-71.
27. Hill SA, Masters TL, Wachter J. Gonorrhea evolving disease of the new millennium. Microb cell 2016; 3:361-88.
28. Parsapour H, Alizamir A, Khansary Sh, et al. The frequency of Neisseria gonorrhoeae endocervical infection and its antibiotic resistance pattern in women referred to gynecology clinic of Fatemieh Hospital in Hamadan in 2020. J Obstetrics Gynecol Cancer Res 2022; 28:123-40.
29. Yalew E, Wolde M, Ebrahim S, et al. Prevalence and antimicrobial susceptibility pattern of Neisseria gonorrhoeae from selected public health centers, Addis Ababa, Ethiopia. Res Sq 2022.1-11.
30. Dela H, Attram N, Behene E, et al. Risk factors associated with gonorrhea and Chlamydia transmission in selected health facilities in Ghana. BMC Infect Dis 2019; 19:1-8
31. Mabonga E, Manabe YC, Elbireer A, et al. Prevalence and predictors of asymptomatic Chlamidya trachomatis and Neisseria gonorrhoeae in a Ugandan Population most at risk of HIV transmission. Int J STD AIDS 2021; 32(6):510-16.
32. Chang SX, Chen KK, Liu XT, et al. Cross-sectional study of asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infections in sexually transmitted disease related clinics in Shenzhen, China. PLoSOne 2020; 15(6):e0234261.
33. Khariri, Sariadji K. Penerapan Teknik Laboratorium Sederhana Dengan Pewarnaan Gram Untuk Deteksi Cepat Infeksi Neisseria Gonorrhoeae Pada Wanita Penjaja Seks (WPS). Seminar Nasional Cendekiawan 2018;411-16.
34. Nateghi Rostami M, Hossein Rashidi B, Aghsaghloo F, et al. A multiplex assay of Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae infections in genital specimens. J Infect Dev Countries 2017; 11(11):833839.
35. Syarif S, Hadju L, Putri FA. Perbandingan Deteksi Bakteri Neisseria gonorrhoeae pada Urine PSK menggunakan metode konvensional dan metode PCR (Polymerase Chain Reaction) di Puskesmas Perumnas Kota Kendari. J MediLab Mandala Waluyo 2021; 5(1):17-22
36. Marzony I, Yani FF, Efrida D. Uji Diagnostik C-Reactive Protein pada Pneumonia Bakteri Komunitas Anak. Sari Pediatri 2016; 17(5):391-5.
37. Farooqi L, Amini K. Simultaneous molecular identification of Neisseria gonorrhoeae and Toxoplasma gondii from vaginal swabs of infertile women by multiplex polymerase chain reaction. J AUMS 2021;10(3):297-304
38. Ríos-Castillo AG, Ripolles-Avila C, Rodríguez-Jerez JJ. Detection by real-time PCR and conventional culture of Salmonella typhimurium and Listeria monocytogenes adhered to stainless steel surfaces under dry conditions. Food Control 2022; 137:108971.
39. Boiko I, Stepas Y, Krynytska I. Comparison of deferred and bedside culture of Neisseria gonorrhoeae: a study to improve the isolation of gonococci for antimicrobial susceptibility testing. Iranian J Microbiol 2020; 12(3):216
40. Xiu L, Wang L, Li Y, et al. Multicentre clinical evaluation of a molecular diagnostic assay to identify Neisseria gonorrhoeae infection and detect antimicrobial resistance. Int J Antimicrob Agents 2023; 61(5):106785.
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| Issue | Vol 13 No 3 (2025) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jmb.v13i3.19519 | |
| Keywords | ||
| Culture Detection Gonorrhea Neisseria gonorrhoeae PCR. | ||
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How to Cite
1.
Sheikh Eslami B, Aslani MH, Fakhar H, Rezaei F, Rangraz S. Comparison of Culture and PCR Methods in the Detection of Neisseria gonorrhoeae in Patients Suspected of Gonorrhea. J Med Bacteriol. 2025;13(3):50-59.
