Original article

Comparative performance of commercial Amies transport media with

and without charcoal for Neisseria gonorrhoeae culture for gonococcal
isolation and antimicrobial resistance monitoring in Ukraine
Iryna Boiko1,*, Inna Krynytska2

Abstract
Introduction Culture is the only laboratory method that provides live gonococcal isolates for
monitoring antimicrobial resistance. Many clinical settings do not have direct access to laboratories for
the immediate processing of biological samples. Validated and quality-assured transport media are
recommended to maintain the viability of Neisseria gonorrhoeae.
Methods In total, 103 clinical samples were divided into two groups: 51 samples were stored in
Amies agar gel medium containing charcoal and 52 samples were stored in agar gel medium without
charcoal. All samples were stored at 4°C for 0.5-6 h and then transported in a thermo-protected box
within 0.17-0.25 h to the laboratory of Ternopil Regional STI Clinic (Ukraine).
Results The recovery rate was significantly higher for charcoal-containing Amies medium than for
charcoal-free Amies medium (86.27%, 44/51 vs. 59.62%, 31/52). A higher rate of specimens transported
in charcoal-containing Amies medium was isolated within 24 h (84.31%, 43/51), whereas most isolates
from charcoal-free Amies medium grew within 24 h (42.31%, 22/52) or 48 h (17.31%, 9/52). Growth
beyond the first quadrant of the agar plate was registered for 59.09% (26/44) of charcoal-containing
Amies samples, compared with only 19.35% (6/31) of charcoal-free Amies samples.
Conclusions A high rate of N. gonorrhoeae recovery after transport has considerable public health
implications for establishing national antimicrobial susceptibility programs. Charcoal-containing Amies
medium had higher viability rate, and it could be used for diagnostic and isolation purposes in future
antimicrobial susceptibility studies. Continuous validation studies of transport medium for N.
gonorrhoeae culture are needed.
Keywords Neisseria gonorrhoeae, gonorrhea, culture, antimicrobial drug resistance, Ukraine.

Introduction 1 antimicrobials will become extremely limited if

Antimicrobial resistance is a major threat to appropriate actions are not taken nationally and
public health globally. The pipeline of effective internationally.1 Gonococcal infection caused by
Neisseria gonorrhoeae ranks as the second most
common sexually transmitted infection (STI)
Received: 15 August 2020; revised: 03 May 2021; accepted:
31 May 2021.
worldwide.2 Gonococci have a unique ability to
acquire resistance to almost all groups of
1
MD, PhD candidate, Department of Functional and antimicrobials used to treat infected patients.1
Laboratory Diagnostics, I. Horbachevsky Ternopil National Furthermore, self-treatment is widely performed
Medical University, Maidan Voli, 1, Ternopil, 46002,
in countries where antimicrobials are freely
Ukraine; 2Professor, Department of Functional and
Laboratory Diagnostics, I. Horbachevsky Ternopil National available without a prescription.3,4 This
Medical University, Maidan Voli, 1, Ternopil, 46002, inappropriate treatment could promote the
Ukraine. development of antimicrobial resistance in
N. gonorrhoeae.1 Because no vaccine has been
*Corresponding author: Iryna Boiko,
iryna.boiko.ua@gmail.com developed to prevent gonococcal infections, the
management of N. gonorrhoeae relies on highly
Article downloaded from www.germs.ro sensitive and specific diagnostics, notifications of
Published June 2021 sexual partners, effective treatment based on
© GERMS 2021
ISSN 2248 – 2997
updated evidence-based guidelines, and the
ISSN – L = 2248 – 2997 monitoring of the antimicrobial resistance

www.germs.ro • GERMS 11(2) • June 2021 • page 246

 Transport media for Neisseria gonorrhoeae culture – Boiko et al.• Original article
profiles of circulating gonococci.1,5 Effective and
quality-assured antimicrobial susceptibility
programs were implemented in many countries
following a call for emergency actions.1 However,
substantial numbers of countries have not
studied the antimicrobial resistance profile of
their N. gonorrhoeae isolates.5,6
To date, culture is the only laboratory
method for obtaining live gonococcal isolates7 for
investigating antimicrobial resistance phenotypes
as well as molecular and genomic epidemiological
studies.1,3,8 As N. gonorrhoeae is an extremely
fastidious bacterium, point-of-care culture
involving the direct inoculation of biological
samples onto agar plates using nutritive culture
medium and immediate incubation is
recommended.9 The absence of these criteria
results in the loss of gonococcal viability and
false-negative results.10-12 The risk of obtaining
false-negative results hampers the efficacy of
treatment and increases infection transmission.1
Many clinical settings do not have direct
access to laboratories for the immediate
processing of biological samples.11 Validated and
quality-assured transport media are
recommended for these situations.12-15 Non-
nutritive transport media such as Amies and
Stuart media supplemented with charcoal were
identified as quality tools for the temporary
storage and transport of fastidious
microorganisms, including N. gonorrhoeae, based
on their ability to maintain the viability of
gonococci for 24-48 h at 2-8°C.9,13 Nutritive
transport media can be used to store and
transport biological samples for more than 48 h
with a maximum survival rate after preincubation
in transport medium at 36±1°C overnight before
transportation to the laboratory.9 However, it is
difficult to ensure an uninterrupted supply of
laboratory reagents, kits, and media in financially
constrained settings in low- and middle-income
countries, including Ukraine.11,12 Moreover,
nutritive transport media were not available for
purchase in Ukraine between 2013 and 2018,
and charcoal-supplemented transport media were
not available in January - May 2018. Under these
conditions, it is essential to validate non-nutritive
transport media for N. gonorrhoeae culture in
www.germs.ro • GERMS 11(2) • June 2021 • page 247
Ukraine to ensure the isolation of N. gonorrhoeae
samples for diagnostic and surveillance purposes
and guarantee the highest possible quality of
culture performance.
To improve the isolation of N. gonorrhoeae for
antimicrobial resistance research in Ukraine, we
evaluated two non-nutritive transport swabs for
N. gonorrhoeae culture that were available for
commercial purchase during the study period:
Amies agar gel medium containing charcoal and
Amies agar gel medium without charcoal.
Methods
Study design
The study design met the guidelines for
investigations of diagnostic accuracy.16
Comparison of the viability of N. gonorrhoeae
clinical isolates using non-nutritive Amies
transport media with and without charcoal was
made to the composite reference standard.
Combining two methods was defined as a
composite reference standard: positive point-of-
care culture using selective agar medium
Chocolate agar™ PolyViteX VCAT3 (BioMérieux
Ltd., France) and the detection of Gram-negative
intracellular diplococci along with leukocytosis in
the male urethral smears by microscopy.
Preliminary diagnosis of N. gonorrhoeae infection
in females was made by detecting intracellular
Gram-negative diplococci in the cervical
discharge. The final diagnosis of gonorrhea in
females was made based on a positive point-of-
care culture.3,12
Patient population
The inclusion criteria for patients were
urogenital discharges as clinical symptoms,
detection of Gram-negative intracellular
diplococci in urethral smears from males, or
cervical smears from females along with
leukocytosis. All females were enrolled as
contacts to infected partners. Exclusion criteria
were treatment with antimicrobials either
systematically or using local medications one
month before the visit, refusing to sign informed
consent, females who had used a vaginal douche
in the past seven days, and menstruation or
pregnancy in females. We enrolled 103
 Transport media for Neisseria gonorrhoeae culture – Boiko et al.• Original article
symptomatic patients, including 88 (85.44%)
men and 15 (14.56%) women, aged 26.62 ± 6.83
years (age range: 18-80 years; median age 23 years)
who visited the Ternopil Regional STI Clinic
(Ukraine) from December 2015 to October 2018
and met all inclusion criteria. The most prevalent
clinical symptoms in males were urethral
discharge (100%, 88/88), discomfort during
urination (13.64%, 12/88), and burning
sensation (5.68%, 5/88). In females, the most
common clinical symptoms were vaginal
discharge (100%, 15/15) and lower abdominal
pain (6.67%, 1/15).
All patients received treatment for gonorrhea
and concomitant STIs according to the guidelines
of the Ministry of Health of Ukraine issued in
2004 and 2009.3,4
Biological specimens
Two clinical urogenital specimens for point-
of-care culture and Amies transport medium were
simultaneously collected from the urethra in men
and cervix in women. Biological samples were
randomly divided into two groups according to
the non-nutritive transport medium used for
temporary storage: odd samples (n=51) were
stored in charcoal-containing Amies medium
(Copan Diagnostics Inc., Brescia, Italia), and
even samples (n=52) were stored in charcoal-free
Amies medium (Jiangsu Suyun Medical Materials
Co., Ltd, China). All samples were held at 4°C
for 1.29 ± 0.78 h (range time: 0.5-6 h; median
time: 1 h; interquartile range (IQR) 0.5-1.5 h),
depending on how close the patients' visits were
to the time of transportation of samples to the
laboratory (one scheduled transportation per
clinician's working hours). Samples were
transported in a thermo-protected box to the
laboratory of the Ternopil Regional STI Clinic
within 0.2 ± 0.03 h (time range: 0.17-0.25 h;
median time: 0.2 h; IQR: 0.18-0.23 h).
Temporary storage time in the laboratory before
processing was with range 0.5-1 h (median time:
0.6 h; IQR: 0.52-0.74 h) for all samples. Thus,
the total time between sampling and culturing
was within 1.2-6.9 h (median time: 1.8 h; IQR:
1.4-2.3 h) for all samples and, notably, it did not
differ between the two studied groups.
www.germs.ro • GERMS 11(2) • June 2021 • page 248
N. gonorrhoeae culture
Laboratory specialists inoculated swabs from
the transport media onto 90-mm agar plates
containing Chocolate agar™ PolyViteX VCAT3
medium with a combination of antimicrobial and
antifungal agents added by the manufacturer to
enhance the selectivity (vancomycin, colistin,
amphotericin B, and trimethoprim). All samples
were incubated at 36 ± 1 °C in a humid candle
jar for 24-48 h and, if negative, for up to 7 days
according to the national laboratory guidelines.
Isolates were confirmed as N. gonorrhoeae by the
identification of Gram-negative diplococci on
microscopy, rapid oxidase test (OXItest diagnostic
strips, Microlatest, Czech Republic) positivity,
and rapid sugar utilization test (Neisseria-test,
PLIVA – Lachema Diagnostika s.r.o., Czech
Republic) positivity. The results were considered
positive when at least one typical colony was
present and confirmed as N. gonorrhoeae.
Criteria for transport medium evaluation
The cultures of N. gonorrhoeae were compared
for differences in recovery (isolation) rates, the
time required for isolation, and growth grades.
The criteria for growth from culture swabs were
previously described.17 In our study, we
categorized all samples into two groups: samples
with growth within the first quadrant of the Petri
dish (grades 1 and 2) and samples with growth
beyond the first quadrant (grades 3-5). The
criteria for evaluating N. gonorrhoeae growth from
cultured swabs are presented in Table 1.
Table 1. Criteria for evaluating Neisseria
gonorrhoeae growth from cultured swabs
Description of growth on the
Group Gradea
agar plate
Growth 1 1-50 colonies in the first
within the quadrant
first 2 ˃50 colonies in the first
quadrant quadrant
3 Growth in the first and
Growth
second quadrants
beyond
4 Growth in the first, second,
the first
and third quadrants
quadrant
5 Growth in all four quadrants
a
Criteria for growth from culture swabs were as
previously described.17
 Transport media for Neisseria gonorrhoeae culture – Boiko et al.• Original article
Statistical analysis
Descriptive data are presented as frequencies
and percentages. The 95% confidence intervals
(CIs) were calculated using the exact binomial
distribution method. P<0.05 denoted statistical
significance. Statistical analysis was performed
using MedCalc Statistical Software version 19.3.1
(MedCalc Software bvba, Belgium).
Ethical approval
The Bioethics Commission of I.
Horbachevsky Ternopil State Medical University
(Ukraine) approved the study (Excerpts from
Minutes No. 29, dated 05.20.2015) and
publication of data (Experts from Minutes No.
63, dated 15.03.2021).
Results
The proportions of recovered and dead
N. gonorrhoeae clinical isolates depending on using
transport media are displayed in Table 2.
Briefly, the viability of gonococcal isolates
was significantly higher for charcoal-containing
Amies medium than for charcoal-free Amies
medium (86.27%, 44/51 vs. 59.62%, 31/52,
respectively). The rate of dead isolates was lower
in the charcoal-containing Amies medium
(13.73%, 7/51) compared with the charcoal-free
Amies medium (40.38%, 21/52, p=0.003).
The results of N. gonorrhoeae cultures from
transport swabs based on the duration of
incubation are provided in Table 3.
The vast majority of specimens were isolated
significantly faster (within 24 h) using the
charcoal-containing Amies medium (84.31%,
43/51). In contrast, growth within 24 h (42.31%,
22/52) and 48 h (17.31%, 9/52) was observed
for isolates from the charcoal-free medium. No
isolates grew later than 48 h.
The results of N. gonorrhoeae growth for
isolates obtained from the two types of culture
swabs are presented in Table 4.
Bacterial growth was significantly more
enriched for isolates obtained from charcoal-
containing Amies medium than medium lacking
charcoal. Specifically, growth beyond the first
quadrant of the agar plate was registered for
59.09% (26/44) of isolates from charcoal-
www.germs.ro • GERMS 11(2) • June 2021 • page 249
containing Amies medium, versus 19.35% (6/31)
of isolates from charcoal-free Amies medium.
Discussion
The validation of alternative transport media
options is urgently required in Ukraine and other
low- or middle-income countries due to
restrictions on the availability of laboratory
supplies. On the other hand, not many reports
on the efficacy of N. gonorrhoeae recovery were
retrieved. Thus, we performed this comparative
study of Amies transport media with and without
charcoal using clinical urogenital samples from
adult patients with urogenital discharge and a
confirmed diagnosis of gonorrhea to improve the
isolation of N. gonorrhoeae under resource-
constricted conditions. Our results comply with
recently published studies and support
recommendations to validate commercially
available culture transport media for N.
gonorrhoeae isolation before using them in
laboratory practice.19,20-24
The minimum recommended sensitivity of
culture for isolation N. gonorrhoeae is 85%.20
Arbique JC et al. found that various non-nutritive
transport media with and without charcoal could
maintain 94% and 82% of N. gonorrhoeae viability
for 24 h, respectively.21 We obtained an
acceptable viability rate (86.27%) of N.
gonorrhoeae culture using Amies transport
medium with charcoal for a temporary storage
time of 1.2-6.9 h. A suboptimal recovery rate
(59.62%) was obtained for Amies transport
medium without charcoal. Previous studies
suggested that the viability of N. gonorrhoeae
isolates has a negative correlation with the
duration of temporary storage in the transport
media.15,17,21-24 The laboratory guidelines
recommend to perform pre-analytical processing
as fast as possible, even using transport
media.9,13,20 Results from our study agree with
earlier published reports that the risk of lost
viability of N. gonorrhoeae is higher in the cases of
using Amies transport media without
charcoal. 21,22,24
Worryingly, some laboratories
operating under limited resource settings
continue to use media with suboptimal
sensitivity.7,11,25 Our study highlights that the
 Transport media for Neisseria gonorrhoeae culture – Boiko et al.• Original article

Table 2. Viability of gonococcal isolates in Amies transport medium

Viability of Types of Amies transport medium
Neisseria gonorrhoeae P value
isolates With charcoal, n=51 Without charcoal, n=52
n 44 31
Recovered
% 86.27 59.62 0.003
isolates
95% CI 73.74-94.30 45.11-73.00
n 7 21
Dead
% 13.73 40.38 0.003
isolates
95% CI 5.70-26.26 27.00-54.89
CI – confidence interval.

Table 3. Recovery of Neisseria gonorrhoeae isolates from two types of Amies transport swabs
depending on the incubation time
Types of Amies transport medium
Incubation time P value
With charcoal, n=51 Without charcoal, n=52
n 43 22
24 h % 84.31 42.31 <0.0001
95% CI 71.41-92.97 28.73-56.80
n 1 9
48 h % 1.96 17.31
95% CI 0.05-10.45 8.23-30.33 0.009
n 0 0
72 ha % 0 0 NA
95% CI 0-6.98 0-6.85
a
If negative, up to 7 days.
CI – confidence interval; NA – not applicable.

Table 4. Evaluation of the growth of Neisseria gonorrhoeae isolates obtained from two types of Amies
transport swabs
Grades of N. Types of Amies transport medium P value
gonorrhoeae growth With charcoal, n=44 Without charcoal, n=31
n 18 25
1-2 % 40.91 80.65 0.0007
95% CI 26.34-56.75 62.53-92.55
n 26 6
3-5 % 59.09 19.35 0.0007
95% CI 43.25-73.66 7.45-37.47
CI – confidence interval.

recovery rate of gonococcal isolates might vary
widely across different commercial media.
Therefore, validation of media is essential before
using any media in laboratory practice.9,13,19,21
The duration of sample incubation is an
important criterion for N. gonorrhoeae culture.9,21
For example, issues will arise for samples cultured
on Thursday and provide colonies within 48 h or
more, i.e., over the weekend. Many laboratories
do not work during weekends. Thus, the risk
exists to obtain nonviable isolates on Monday.
Dead N. gonorrhoeae isolates might be acceptable

www.germs.ro • GERMS 11(2) • June 2021 • page 250

 Transport media for Neisseria gonorrhoeae culture – Boiko et al.• Original article
only for diagnostic purposes, but they cannot be
used for antimicrobial susceptibility testing. Only
fresh N. gonorrhoeae isolates cultured within 18-
24 h should be collected for further antimicrobial
resistance study.9 Our testing showed that N.
gonorrhoeae isolates grew significantly faster and
within 24 h using Amies transport media with
charcoal than without charcoal (84.31% vs
42.31%, respectively; p˂0.0001). Almost one-fifth
of N. gonorrhoeae isolates (17.31%) were obtained
within 48 h using Amies transport media without
charcoal, compared with only 1.96% cases using
Amies transport medium with charcoal.
Substantially prolonged laboratory processing
could complicate the isolation of such fastidious
bacteria as N. gonorrhoeae for antimicrobial
susceptibility testing.20,23
Most laboratories cannot perform
antimicrobial susceptibility testing in routine
practice. Specialized leading reference
microbiology laboratories support antimicrobial
susceptibility testing in many countries.6 N.
gonorrhoeae antimicrobial susceptibility programs
are mainly designed as retrospective studies when
viable isolates are preserved and stored under
particular conditions.9 To investigate N.
gonorrhoeae antimicrobial resistance, the
maximum amount of fresh (18-24 h) pure
gonococcal colonies from the agar plate should
be collected, preserved, and transported to the
laboratories.9 This is crucial to ensure a high
restored rate of gonococcal isolates before
antimicrobial susceptibility testing. Our study
showed that significantly strong growth was
obtained using Amies transport media with
charcoal (59.09%, p=0.0007). Most isolates
(80.65%) stored in the Amies transport medium
without charcoal showed restricted growth, an
equivalent area of only one quadrant of the Petri
dish. Insufficient collection of N. gonorrhoeae
colonies from Petri dish could decrease bacterial
viability during temporary storage before
antimicrobial susceptibility testing.9 In such
circumstances, the criteria of growth grades
described previously by Farhat SE et al.17 have
practical meaning and could be used for further
evaluation testing. Thus, comparing the two types
of Amies transport media according to the grades
www.germs.ro • GERMS 11(2) • June 2021 • page 251
of N. gonorrhoeae growth is one of the present
study's strengths.
Another key strength of our study is the
comparison of the ability to maintain the viability
of N. gonorrhoeae using commercially available
non-nutritive Amies transport media in Ukraine.
According to good laboratory practice, validation
of the performance characteristics of media for
fastidious bacteria like gonococcus is
essential.9,13,19 The main output of our study was
the improvement of local laboratory operating
procedures and provided data for updating
national laboratory guidelines. This primary step
could help implement antimicrobial surveillance
programs for the antimicrobial resistance of N.
gonorrhoeae in resource-constrained countries.
The data of the present study impact the
diagnostics of gonorrhea in the Ternopil
Regional STI Clinic (Ukraine). We have changed
the standard operating procedures for collection,
temporary storage, and transportation of
biological material with the suggestion of using
non-nutrition Amies transport media with
charcoal. For the first time, we performed the
pilot collection of 150 clinical N. gonorrhoeae
isolates that circulated in two regions (Ternopil,
n=136; and Dnipropetrovsk, n=14) in Ukraine in
2013-2018.3,8 This has allowed us to perform for
the first time an antimicrobial resistance study of
these collected isolates from Ukraine using
international quality-assured methods (E-test and
whole-genome sequence) as previously
described.3,8 Interestingly, none of the isolates
from Ukraine were phenotypically resistant to
ceftriaxone, cefixime, azithromycin,
spectinomycin, or gentamicin. Resistance to
benzylpenicillin was detected in only 0.7% of
isolates, and 0.7% of isolates had a borderline
resistance to the extended-spectrum
cephalosporins and belonged to the
internationally spreading multidrug-resistant NG-
MAST ST1407, MLST ST1901 clone.3,8
Resistance to benzylpenicillin and/or decreased
susceptibility to β-lactam antimicrobials were
associated with the mosaic penA-34.001 allele
(2.7%), β-lactamase production (0.7%), mtrR
(11.3%), penB (12.7%) and the ponA1 mutation
(16.7%).8 Moreover, 11.3% of isolates were
 Transport media for Neisseria gonorrhoeae culture – Boiko et al.• Original article
resistant to ciprofloxacin due to gyrA gene
mutations (11.3%) and parC gene mutations
(8.7%).3,8 Resistance to tetracycline was detected
in 6% of isolates and was caused by the rpsJ
V57M mutation (16.7%) and/or presence of tetM
(4.7%).3,8 Our data support the need to study
antimicrobial resistance nationally and
internationally because geographical diversity of
gonococcal strains could be present due to the
high genetic plasticity of N. gonorrhoeae.1,5,6
However, our study has several limitations.
First, no reference strains were included because
they were not available in Ukraine during the
study period. Second, no extragenital specimens
were tested. Additionally, the study was
performed in only one laboratory, and a
comparatively low number of tested clinical
specimens were included. We did not split the
clinical specimens from the same patients
between the two types of Amies transport media,
as we could not oversample patients. Future
research addressing these limitations would be
valuable, including reference and clinical strains
with different concentrations to avoid bacterial
load and sampling procedure as possible biases.
Furthermore, as molecular tests were not
available in our setting, we used a composite
reference standard with a combination of
microscopy and culture methods.7,16,18 Previously
published analytical studies of the diagnostic
characteristics of microscopy and culture
compared with the international reference
nucleic acid amplification tests (NAATs)
established a high specificity of culture (100%)
and microscopy of urogenital specimens (99.8-
100%).10,25 However, the sensitivity of microscopy
and culture for gonococcal infection is
suboptimal, i.e. 71.4% and 57.1%, respectively.10
Moreover, the diagnostic sensitivity of
microscopy of cervical specimens in females
(31.8-50%) is crucially lower than of urethral
smears in males (75-80%).10,25 Notably, the
performance of culture for N. gonorrhoeae could
vary widely in different clinical settings due to the
quality of media, timely updating of local
standard operating procedures and national
guidelines, as well as the professional knowledge
of laboratory specialists.7,25 Thus, an extensive
www.germs.ro • GERMS 11(2) • June 2021 • page 252
amount of gonorrhea cases remain undetected in
clinical settings without access to NAATs.2,7,14
The fact that we enrolled symptomatic
patients with positive microscopy in our study, as
well as a point-of-care culture of N. gonorrhoeae,
could explain that the bacterial load in the tested
samples was higher than that in asymptomatic
gonorrhea cases and/or cases with positive-only
NAATs results along with negative microscopy
and/or culture results. The high initial bacterial
load in the urogenital samples benefits the
recovery of N. gonorrhoeae.22 We can assume that
the logistic choices could differ among
asymptomatic patients with preference for using
point-of-care culture or nutritive transport
media.9 A future extensive study including highly
sensitive and specific, quality-assured NAATs as a
reference method among symptomatic and
asymptomatic patients would be extremely
valuable for ensuring the use of transport media
with the best performance characteristics.
Conclusions
Transport media are crucial for maintaining
the viability of microorganisms in situations in
which sites cannot perform point-of-care cultures
of isolated gonococci. The widespread
implementation of validated transport media is
essential internationally for fastidious bacteria
such as N. gonorrhoeae. Increased recovery of N.
gonorrhoeae after transport may have important
public health implications for the establishment
of national antimicrobial susceptibility programs.
Our study revealed that charcoal-supplemented
Amies medium has optimal sensitivity and
gonococcal growth grades, making it potentially
useful for diagnostic and isolation purposes in
future antimicrobial susceptibility studies.
Continuous validation research of transport
media for N. gonorrhoeae culture should be
implemented in routine laboratory practice
nationally and internationally.
Authors’ contributions statement: IB designed the study,
collected the isolates, performed all laboratory analyses, and
wrote the first draft of the paper. IK approved the study
design. IB and IK analyzed and interpreted all data. All
authors read, commented on, and approved the final
manuscript.
 Transport media for Neisseria gonorrhoeae culture – Boiko et al.• Original article
Conflicts of interest: All authors – none to declare.
Funding: None to declare.
Acknowledgements: The authors are grateful to Oleksandr
I. Khara for the substantial and invaluable support to the
study as part of the quality control program in the laboratory
of the Ternopil Regional STI Clinic. The authors also thank
Luidmyla P. Gayova, Volodymyr V. Romaniv, Valentyna Y.
Grytsuik, Ihor Kohut, Lilia Ivachova, and Inna Shumeiko
(Ternopil Regional STI Clinic) for their clinical and
technical assistance. The authors thank Enago
(www.enago.com) for the English language review of the
manuscript.
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Please cite this article as:

Boiko I, Krynytska I. Comparative performance of commercial Amies transport media with and
without charcoal for Neisseria gonorrhoeae culture for gonococcal isolation and antimicrobial
resistance monitoring in Ukraine. GERMS. 2021;11(2):246-254. doi: 10.18683/germs.2021.1261

www.germs.ro • GERMS 11(2) • June 2021 • page 254