P035 The sensitivity and associated features of culture positive rectal gonorrhoea in men who have sex with men

Background Rectal Neisseria gonorrhoea is an important sexually transmitted infection in men who have sex with men (MSM). The past decade has seen and increasing rates of rectal gonorrhoea and antimicrobial resistant (AMR) gonorrhoea associated with recreational drug use, geo-spacial mobile phone dating apps and HIV risk reduction strategies including undetectable = untransmissible (U=U) and HIV pre-exposure prophylaxis (PrEP). Our aims were to review the microbiological findings and clinical characteristics of MSM with rectal gonorrhoea. Methods A cross sectional study between January 2018-December 2019 to characterise the clinical and laboratory features of MSM with rectal gonorrhoea from our large clinic population of MSM attending the sexual health clinic in Brighton, UK. Results There were 12,186 MSM attendances during the study period, of which 379/12186 (3.1%, CI=2.8–3.4) had a positive rectal gonorrhoea NAAT. The median age was 34 (IQR= 27–34), 103/379 (27%) were HIV positive and 72/379 (19%) also had rectal Chlamydia. HIV positive MSM with rectal gonorrhoea were significantly older than HIV negative MSM (p=0001). 73/379 (19%, 95%CI= 15.6 to 23.5) presented with ano-rectal symptoms. Gonorrhoea culture was performed in 291/379 (77%) overall and was positive in 190/291(65%); MSM with symptomatic gonorrhoea were more likely to be culture positive than asymptomatic MSM (OR= 8.04, CI 3.34–19.35, p>0.0001). There were no differences in age or HIV status between MSM with symptomatic versus asymptomatic mono or dual (Chlamydia) infections. Conclusion Most MSM with rectal gonorrhoea are asymptomatic and asymptomatic MSM are significantly less likely to have gonorrhoea cultures taken and have a positive culture than symptomatic MSM. Measures are needed to ensure that all MSM (including asymptomatic) with rectal gonorrhoea have cultures taken prior to treatment to maintain adequate surveillance of AMR to prevent the urgent threat of multidrug resistance to gonorrhoea in MSM.