Positive Rmp Antibody Test Result
A positive Rmp (reduction-modifiable protein, also known as outer membrane protein 3) antibody test indicates prior exposure to Neisseria gonorrhoeae and paradoxically increases susceptibility to future gonococcal infections rather than providing protection. 1
What This Result Indicates
Rmp antibodies reflect past gonococcal infection but do not confer immunity; instead, they are associated with a 3.4-fold increased risk of subsequent N. gonorrhoeae infection (adjusted odds ratio 3.4, CI95% 1.1-10.4, P < 0.05). 1
Rmp is a highly conserved outer membrane protein present across gonococcal strains that appears to function by blocking mucosal immune defenses, allowing the bacteria to evade protective immune responses. 1
This antibody response represents an immune evasion strategy by the pathogen rather than a protective immune response, which explains why N. gonorrhoeae remains an ecologically successful obligate human pathogen despite frequent human exposure. 1
Recommended Course of Action
Immediate Clinical Assessment
Screen for active gonococcal infection with nucleic acid amplification testing (NAAT) from appropriate anatomic sites (urogenital, pharyngeal, rectal) based on sexual practices, as Rmp antibody positivity indicates increased infection risk. 1
Test for concurrent sexually transmitted infections including Chlamydia trachomatis, HIV, and syphilis, given the epidemiologic association between Rmp antibody positivity and high-risk sexual behavior. 1
Assess HIV status specifically, as HIV infection was independently associated with increased gonococcal infection risk in the cohort where Rmp antibody effects were identified. 1
Risk Counseling and Prevention
Counsel patients that Rmp antibody positivity indicates heightened susceptibility to future gonococcal infections rather than immunity, emphasizing the need for consistent barrier protection methods. 1
Implement more frequent STI screening intervals (every 3 months rather than standard 6-12 months) for individuals with positive Rmp antibodies who remain sexually active with multiple or new partners. 1
Provide comprehensive sexual health education focusing on condom use, partner notification, and early symptom recognition, as these individuals are at demonstrably higher risk for reinfection. 1
Important Caveats
Rmp antibody testing is not routinely performed in clinical practice and is primarily a research tool; most clinicians will never encounter this test result outside of specialized epidemiologic studies. 1
Do not confuse Rmp antibodies with rickettsial antibodies, which have entirely different clinical implications related to tick-borne diseases and require different management approaches. 2
Antibody positivity alone does not indicate active infection and should not trigger treatment in asymptomatic individuals; only positive NAAT results warrant antimicrobial therapy for gonorrhea. 1, 3