The Problem with Clap in the Yap — A Valentines Day Post

By anonymous, NAAT-savvy laboratory scientist

The Problem with Clap in the Yap -- A Valentines Day Post | www.aphlblog.org

Valentine’s Day is typically a time to express heartfelt wishes to loved ones and close friends. The preceding days are the busiest for florists as sales spike from people who are programmed to translate botanic gifts into signals of love. If these gifts and unspoken intentions are accepted, sexual advancement may start with a kiss and end with a variety of infectious sensations—some perhaps a little more nefarious than others. Gonorrhea, anyone?

Gonorrhea is the second most common notifiable communicable disease in the US right behind chlamydia, the ubiquitous love bug. Many of the colloquial terms of gonorrhea, such as GC (Gentlemen’s Complaint), clap, dripsy and morning dewdrop were derived from symptomatic infection in the male reproductive tract. Transmission requires some form of insertive behavior since gonorrhea does not remain viable for extended periods outside of human bodies. However, gonorrhea does not discriminate between anatomic sites and will infect non-genital mucosa (including one’s oral cavity) as well as genital mucosa.

Getting clap in the yap may not seem like a big deal since it’s not associated with any colloquialisms, but there are risks for disease and transmission.  While most infections are asymptomatic, one study showed that sore throats were reported in 15% of patients that had an oropharyngeal gonococcal infection and purulent tonsillitis was observed in 5%. Laboratory diagnosis of gonorrhea in the oropharynx can be made by traditional methods of culture isolation and biochemical identification. However, most public health laboratories have abandoned these procedures  with the use of nucleic acid amplification tests (NAATs) replacing culture as the primary laboratory test since NAATs can detect the organism in a wider range of clinical specimens independent of viability. However, the use of NAATs is complicated since they are not cleared by the FDA for specimens collected from non-genital anatomic sites and laboratories need to perform an off-label verification study to satisfy CLIA requirements. Some but not all commercially available NAATs may cross-react with non-gonococcal Neisseria species and these commensals are typically found in a higher numbers in the oropharynx. Even though NAATs are not FDA cleared for non-genital tract specimens and some may yield a false-positive result, APHL published a report that was developed from a meeting with CDC and laboratory experts recommending the use of NAATs to detect chlamydia and gonorrhea from rectal and oropharyngeal specimens.

Luckily, gonorrhea is a treatable disease.  Current CDC treatment recommendations are available at http://www.cdc.gov/std/treatment. However, even though it’s treatable today, gonorrhea has developed resistance to several antibiotics over time after acquiring a gene from another bacteria species.

Gonorrhea loves to hook-up with other bacteria and the oropharynx may be analogous to a bacterial brothel for genetic sharing. If oropharyngeal gonorrhea isn’t treated quickly and correctly, there is an increased chance of developing new drug resistance and infections requiring protracted therapy. Though ceftriaxone resistant gonorrhea has not been detected in the US, the first case was found in the throat of a woman in Japan.

The adage that ‘no money, no honey’ has been drilled into people at Valentine’s Day may be difficult to change. Flowers are the primary choice for mental lubrication, but other options exist such as plays and shows.  However, if any involve clowns, be certain that none are named “Dripsy.”

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