{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T18:51:58Z","timestamp":1784573518234,"version":"3.55.0"},"reference-count":12,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,5,6]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To investigate\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      specimens that exhibit diagnostic escape when the gonococcal\n                      <jats:italic>porA<\/jats:italic>\n                      pseudogene is employed as the target of nucleic-acid amplification tests (NAATs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Eight NAAT specimens, from five patients, were identified as potential\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      diagnostic escape mutants over a 7-month period (2023\u20132024) in Scotland. All specimens tested positive for\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      on the first-line NAAT, which uses the\n                      <jats:italic>opa<\/jats:italic>\n                      gene target. However, all tested\n                      <jats:italic>porA<\/jats:italic>\n                      negative with confirmatory testing using a NAAT which included both\n                      <jats:italic>opa<\/jats:italic>\n                      and\n                      <jats:italic>porA<\/jats:italic>\n                      targets. To investigate these false-negative results, whole genome sequencing was performed on available gonococcal isolates (n=4) from the three patients in which cultures had been collected, and a nested PCR approach was applied directly to NAAT specimens for the remaining two patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      isolates were all multilocus sequence type ST-9363, a common genotype. However, these genomes harboured a neisserial\n                      <jats:italic>porA<\/jats:italic>\n                      gene (NEIS1364, allele 3890) typically found in\n                      <jats:italic>Neisseria meningitidis<\/jats:italic>\n                      . This meningococcal\n                      <jats:italic>porA<\/jats:italic>\n                      gene is not detected in the\n                      <jats:italic>N. gonorrhoeae porA<\/jats:italic>\n                      pseudogene confirmation assay, resulting in false negative results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      We report a novel strain of\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      containing a\n                      <jats:italic>porA<\/jats:italic>\n                      gene derived from\n                      <jats:italic>N. meningitidis<\/jats:italic>\n                      resulting in diagnostic escape when using a commonly employed\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      NAAT target. While our findings suggest this may be a local cluster, ongoing vigilance is required both within the diagnostic and sexual health communities to prevent misdiagnoses and maintain diagnostic assurance.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056520","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T05:30:30Z","timestamp":1748496630000},"page":"100-102","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Local cluster of gonorrhoea strains harbouring the\n                    <i>Neisseria meningitidis porA<\/i>\n                    gene: a re-emerging diagnostic escape mutant"],"prefix":"10.1136","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4212-6819","authenticated-orcid":false,"given":"Emily","family":"Goldstein","sequence":"first","affiliation":[{"name":"West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roisin","family":"Ure","sequence":"additional","affiliation":[{"name":"Bacterial Respiratory Infections Service, Scottish Microbiology Reference Laboratory, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8293-9462","authenticated-orcid":false,"given":"Andrew","family":"Winter","sequence":"additional","affiliation":[{"name":"Sandyford Sexual Health Services, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Currie","sequence":"additional","affiliation":[{"name":"Sexual Health Services, NHS Lanarkshire, Scotland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"McHugh","sequence":"additional","affiliation":[{"name":"Scottish Bacterial STI Reference Laboratory, NHS Lothian, Edinburgh, UK"},{"name":"School of Medicine, University of St Andrews, Infection and Global Health Division, St Andrews, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Doumith","sequence":"additional","affiliation":[{"name":"STI Reference Laboratory, UKHSA, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-6910","authenticated-orcid":false,"given":"Michelle Jayne","family":"Cole","sequence":"additional","affiliation":[{"name":"Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UKHSA, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Smith","sequence":"additional","affiliation":[{"name":"Bacterial Respiratory Infections Service, Scottish Microbiology Reference Laboratory, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK"},{"name":"Glasgow Dental Hospital and School, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, Scotland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rory N","family":"Gunson","sequence":"additional","affiliation":[{"name":"West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"2026021702100699000_102.2.100.1","unstructured":"Migchelsen SJ , Edney J , O\u2019Brien N , et al . Sexually transmitted infections and screening for chlamydia in England, 2023. London: UK Health Security Agency, 2024."},{"key":"2026021702100699000_102.2.100.2","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.02068-18","article-title":"Factors That Influence Confirmation of Neisseria gonorrhoeae Positivity by Molecular Methods","volume":"57","author":"Cuschieri","year":"2019","journal-title":"J Clin Microbiol"},{"key":"2026021702100699000_102.2.100.3","doi-asserted-by":"publisher","DOI":"10.1177\/0956462419886775"},{"key":"2026021702100699000_102.2.100.4","doi-asserted-by":"publisher","DOI":"10.1099\/mic.0.055459-0"},{"key":"2026021702100699000_102.2.100.5","doi-asserted-by":"crossref","DOI":"10.12688\/wellcomeopenres.14826.1","article-title":"Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications","volume":"3","author":"Jolley","year":"2018","journal-title":"Wellcome Open Res"},{"key":"2026021702100699000_102.2.100.6","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.39.4.1553-1558.2001"},{"key":"2026021702100699000_102.2.100.7","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.05078-0"},{"key":"2026021702100699000_102.2.100.8","doi-asserted-by":"crossref","DOI":"10.2807\/ese.16.21.19874-en","article-title":"False-negative results using Neisseria gonorrhoeae porA pseudogene PCR - a clinical gonococcal isolate with an N. meningitidis porA sequence, Australia, March 2011","volume":"16","author":"Whiley","year":"2011","journal-title":"Euro Surveill"},{"key":"2026021702100699000_102.2.100.9","doi-asserted-by":"crossref","DOI":"10.2807\/ese.17.09.20101-en","article-title":"Identification of Neisseria gonorrhoeae isolates with a recombinant porA gene in Scotland, United Kingdom, 2010 to 2011","volume":"17","author":"Eastick","year":"2012","journal-title":"Euro Surveill"},{"key":"2026021702100699000_102.2.100.10","doi-asserted-by":"crossref","DOI":"10.2807\/ese.17.09.20102-en","article-title":"Clinical Neisseria gonorrhoeae isolate with a N. meningitidis porA gene and no prolyliminopeptidase activity, Sweden, 2011: danger of false-negative genetic and culture diagnostic results","volume":"17","author":"Golparian","year":"2012","journal-title":"Euro Surveill"},{"key":"2026021702100699000_102.2.100.11","doi-asserted-by":"publisher","DOI":"10.1071\/SH16162"},{"key":"2026021702100699000_102.2.100.12","doi-asserted-by":"publisher","DOI":"10.2353\/jmoldx.2006.050045"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056520","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T10:10:25Z","timestamp":1771323025000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056520"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,28]]},"references-count":12,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,17]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/sextrans-2025-056520"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056520","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,28]]}}}