A recent Commentary in this journal¹ encourages wider implementation of nucleic-acid amplification tests (NAATs) to detect gonorrhoea (GC). We have used GC NAATs (APTIMA Combo2; Gen-Probe Inc., San Diego, California, USA) since 2003, with high uptake, in a Liverpool chlamydia screening population and with referral of GC-positive patients to our local genitourinary medicine (GUM) clinic for management.² We have now observed a doubling of female cases of GC and a reversal of the downward trend for male GC as reported through KC60, the national indicator of GC activity that is based on central reporting but essentially only of cases seen at GUM clinics. For female patients (fig 1A), compared to a 4-year average baseline (2000–2003) of 101 cases/year, KC60 reports showed an extra 51 cases in 2004 and an extra 99 cases in 2005. These extra numbers reflect closely the 45 cases in 2004 and the 107 cases in 2005 detected by concomitant screening for GC in the community chlamydia screening programme. For male patients (fig 1B), the upturn in KC60 reports can be matched to the total of cases detected directly by community screening plus by contact tracing of female community cases (assumed 50% success).

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

 Comparison of GC cases from KC60 returns and GC cases found during chlamydia screening of (A) female patients and (B) ale patients (direct testing plus assumed 50% contact tracing of female patients).

This significant local impact on detection of GC cases suggests that concomitant/dual testing in the community can benefit the wider provision of services for sexual health. Empirical evidence gained from screening in Liverpool has been recognised by the Cheshire and Merseyside Sexual Health Network; the development of a care pathway for asymptomatic low-risk individuals recommends concomitant screening for chlamydia and gonorrhoea using APTIMA.³ This facilitates prompt, easy access to more comprehensive screening for sexually transmitted infections at a wide range of venues, and may also promote opportunities for increased participation in the National Chlamydia Screening Programme.

In addition, with regard to data collection, KC60 data is an important tool in assessing progress towards the Department of Health target for a 25% reduction in cases of GC diagnosed at GUM clinics.⁴ Consideration of changes to KC60 reporting may be needed to prevent increased use of GC NAATs and/or dual testing in the community becoming a confounder to monitoring of this aim.