Oropharyngeal gonorrhoea infections among young heterosexual users of online sexual health services across the island of Ireland.

Objective: There is limited evidence about the prevalence of oropharyngeal gonorrhoea (OPNG) in heterosexuals. To test the hypothesis that the oropharynx acts as a reservoir for gonorrhoea, potentially contributing to high rates of infection, we assessed OPNG positivity in self-sampling individuals.

Methods: From November 2023 to March 2024, SH:24, an online postal self-sampling service, expanded gonorrhoea (NG) nucleic acid amplification testing to include oropharyngeal swabs for heterosexual individuals aged 17-24 years in Northern Ireland and Ireland. Participants were included if they identified as heterosexual with no same or both-gender sexual partners. Positivity was compared by sex and infection site, with χ2 tests. Island-of-Ireland weighted positivity with 95% CI was estimated.

Results: OPNG was detected in 92% (208/226) of NG cases, representing 2.9% (95% CI 2.6 to 3.4) of the tested population. Single-site OPNG infections accounted for 63% (143/226) of cases, corresponding to an overall single-site oropharyngeal positivity of 1.9% (95% CI 1.7 to 2.4). Genital-only infections occurred in 8% (18/226) of cases, while concurrent oral and genital (multisite) infections were identified in 29% (65/226). Overall NG positivity (across all anatomical sites) was 3.2% (226/7009; 95% CI 2.8 to 3.7). Of 12 011 individuals who requested a self-sampling kit, 7036 (58.6%) returned both oropharyngeal and genital swabs suitable for analysis, with valid test results available for 7009 individuals.

Conclusions: Our findings suggest the oropharynx is a common NG infection site among young heterosexuals, often occurring independently of genital infection. Most OPNG cases (63%) did not coincide with genital infection and would have been missed by testing protocols limited to urogenital sites. These results suggest a potential risk for onward transmission, the need to consider a review of testing guidelines in this population and further research to better understand behavioural risk factors associated with OPNG positivity.