{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T13:13:36Z","timestamp":1779196416992,"version":"3.51.4"},"reference-count":22,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,9,8]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Effective surveillance of antimicrobial-resistant\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      (Ng) is crucial, but culturing is labourious and costly. Focusing culturing efforts on high-yield subpopulations can enhance resource utilisation without compromising data quality or care. This cross-sectional retrospective study aims to pinpoint a nucleic acid amplification test (NAAT) cycle threshold (Ct) value for effective Ng surveillance culturing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Surveillance and laboratory data from 3042 sexual health clinic clients in the Netherlands (December 2018 to October 2023) were analysed to determine correlations between Ng culture positivity and NAAT Ct value, culture timing and anatomical location. Fisher\u2019s exact \u03c7\u00b2 test assessed associations between culture recovery and time intervals between NAAT and culture collection. Receiver operator curves and Youden\u2019s J statistic were applied to determine an optimal Ct value cut-off.<\/jats:p>\n                    <jats:p>NAAT was performed on 6346 swabs from urogenital (urethra; 1389\/vagina; 482) and extragenital (oropharynx; 2306\/rectum; 2169) sites using the cobas CT\/NG assay on the 6800 platform (Roche Molecular Systems). Culture plates were inoculated on the initial test day for clients treated presumptively (symptoms or notified for Ng) or during treatment consultation after positive NAAT results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean Ct values differed for positive and negative cultures (negative: Ct 33.0 (IQR 24.2\u201341.9); positive: Ct 25.4 (IQR 20.0\u201330.3); p&lt;0.001). Oropharyngeal samples had the lowest culture positivity rate (22.0%). Culture positivity particularly declined when NAAT to culture intervals exceeded 14 days. Only 0.8% (11\/1389) of urethral culture samples were positive above Ct 30. Between Ct 34 and 35, overall culture positivity dropped from 23.0% to 13.9%. A Ct value cut-off at 34 would reduce basic culturing costs by 25% while missing only 4.2% (108\/2603) of positive cultures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Establishing an NAAT Ct value cut-off can reduce both labour and costs without compromising vital surveillance data. Assay-specific validation is recommended prior to broader application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056542","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T17:21:27Z","timestamp":1760548887000},"page":"232-238","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["To culture or not to culture: correlating\n                    <i>Neisseria gonorrhoeae<\/i>\n                    culture positivity with nucleic acid amplification test cycle threshold values to promote cost-effective gonococcal resistance surveillance"],"prefix":"10.1136","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8612-8413","authenticated-orcid":false,"given":"Kara K","family":"Osbak","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6131-9600","authenticated-orcid":false,"given":"Denise E","family":"Twisk","sequence":"additional","affiliation":[{"name":"Department of Public Health, GGD Rotterdam-Rijnmond, Rotterdam, Netherlands"},{"name":"Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mireille","family":"van Westreenen","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3439-0903","authenticated-orcid":false,"given":"Corn\u00e9","family":"Klaassen","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1236-6224","authenticated-orcid":false,"given":"Hannelore M","family":"G\u00f6tz","sequence":"additional","affiliation":[{"name":"Department of Public Health, GGD Rotterdam-Rijnmond, Rotterdam, Netherlands"},{"name":"Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"2026051905450672000_102.4.232.1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkab082"},{"key":"2026051905450672000_102.4.232.2","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2022.27.34.2200081","article-title":"Trends and regional variations of gonococcal antimicrobial resistance in the Netherlands, 2013 to 2019","volume":"27","author":"Visser","year":"2022","journal-title":"Euro Surveill"},{"key":"2026051905450672000_102.4.232.3","unstructured":"Kayaert L , Sarink D , Visser M , et al . Sexually transmitted infections in the netherlands in 2023. Rijksinstituut Voor Volksgezondheid En Milieu RIVM; 2024."},{"key":"2026051905450672000_102.4.232.4","unstructured":"Rijksinstituut voor Volksgezondheid en Milieu (RIVM) . Draaiboek consult seksuele gezondheid. Bilthoven: RIVM; 2017."},{"key":"2026051905450672000_102.4.232.5","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens9020091","article-title":"The Laboratory Diagnosis of Neisseria gonorrhoeae: Current Testing and Future Demands","volume":"9","author":"Meyer","year":"2020","journal-title":"Pathogens"},{"key":"2026051905450672000_102.4.232.6","doi-asserted-by":"crossref","unstructured":"Unemo M , Ross J , Serwin AB , et al . 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS 2020;956462420949126. doi:10.1177\/0956462420949126","DOI":"10.1177\/0956462420949126"},{"key":"2026051905450672000_102.4.232.7","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000001540"},{"key":"2026051905450672000_102.4.232.8","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2023-055899"},{"key":"2026051905450672000_102.4.232.9","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1080\/14737159.2020.1724093","article-title":"A profile of the cobas\u00ae CT\/NG assay on the cobas\u00ae 6800\/8800 system for detection of Chlamydia trachomatis and Neisseria gonorrhoeae","volume":"20","author":"Van Der Pol","year":"2020","journal-title":"Expert Rev Mol Diagn"},{"key":"2026051905450672000_102.4.232.10","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.01996-18","article-title":"Evaluation of the Performance of the Cobas CT\/NG Test for Use on the Cobas 6800\/8800 Systems for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Male and Female Urogenital Samples","volume":"57","author":"Van Der Pol","year":"2019","journal-title":"J Clin Microbiol"},{"key":"2026051905450672000_102.4.232.11","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.01171-20","article-title":"Men and Women Have Similar Neisseria gonorrhoeae Bacterial Loads: a Comparison of Three Anatomical Sites","volume":"58","author":"van der Veer","year":"2020","journal-title":"J Clin Microbiol"},{"key":"2026051905450672000_102.4.232.12","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2020-054525"},{"key":"2026051905450672000_102.4.232.13","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3"},{"key":"2026051905450672000_102.4.232.14","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1093\/cid\/ciz964","article-title":"What Is the Optimal Testing Strategy for Oropharyngeal Neisseria gonorrhoeae in Men Who Have Sex With Men? Comparing Selective Testing Versus Routine Universal Testing From Dutch Sexually Transmitted Infection Clinic Data (2008-2017)","volume":"71","author":"van Liere","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026051905450672000_102.4.232.15","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1097\/OLQ.0000000000000807","article-title":"Spontaneous Clearance of Pharyngeal Gonococcal Infections: A Retrospective Study in Patients of the Sexually Transmitted Infections Clinic; Amsterdam, the Netherlands; 2012 to 2015","volume":"45","author":"Hananta","year":"2018","journal-title":"Sexual Trans Dis"},{"key":"2026051905450672000_102.4.232.16","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2014-051731"},{"key":"2026051905450672000_102.4.232.17","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2022-055488"},{"key":"2026051905450672000_102.4.232.18","doi-asserted-by":"crossref","DOI":"10.1128\/jcm.00399-22","article-title":"Time to Clearance of Neisseria gonorrhoeae RNA at the Pharynx following Treatment","volume":"60","author":"Barbee","year":"2022","journal-title":"J Clin Microbiol"},{"key":"2026051905450672000_102.4.232.19","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab071"},{"key":"2026051905450672000_102.4.232.20","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000997"},{"key":"2026051905450672000_102.4.232.21","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.37.11.3583-3585.1999"},{"key":"2026051905450672000_102.4.232.22","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01217-11"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056542","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:45:48Z","timestamp":1779194748000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056542"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,15]]},"references-count":22,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,5,19]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/sextrans-2025-056542"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056542","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,15]]}}}