Patterns of extragenital chlamydia and gonorrhea in women and men who have sex with men reporting a history of receptive anal intercourse.
Open accessAbstract
BACKGROUND: Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in men who have sex with men is risk based. Despite high frequencies of oral and receptive anal intercourse (RAI) among women, extragenital screening is not recommended. METHODS: Women (n = 175) and men who have sex with men (n = 224) primarily recruited from a sexually transmitted infection clinic reporting a lifetime history of RAI completed a structured questionnaire and clinician-collected swab samples from the rectum, pharynx, vagina (women), and urine (men). CT and GC were detected using 2 commercial nucleic acid amplification tests (Aptima Combo 2; Hologic, Inc, Bedford, MA; Xpert CT/NG, Cepheid Innovation, Sunnyvale, CA). RESULTS: The median age of the population was 26 years, 62% were white, and 88% were enrolled from a sexually transmitted disease clinic. Men were more likely than women to have GC (22.8% vs. 3.4%) and CT (21.9% vs. 12.6%). In men versus women, GC was detected in 16.5% versus 2.3% of pharyngeal swabs, 11.6% versus 2.3% of rectal swabs, and 5.4% versus 2.9% of urine samples or vaginal swabs. C. trachomatis was detected in 2.2% versus 1.7% of pharyngeal swabs, 17.4% versus 11.4% of rectal swabs, and 4.5% versus 10.3% for urogenital sites in men versus women. Overall 79.6% of CT and 76.5% of GC in men and 18.2% of CT and 16.7% of GC in women were detected only in the pharynx or rectum. CONCLUSION: Reliance on urogenital screening alone misses most of GC and CT in men and more than 15% of infections in women reporting RAI.
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Approximately 70% of gonococcal and chlamydial infections might be missed if urogenital-only testing is performed among MSM because most pharyngeal and rectal infections are asymptomatic.
“Approximately 70% of gonococcal and chlamydial infections might be missed if urogenital-only testing is performed among MSM (212–216) because most pharyngeal and rectal infections are asymptomatic.”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [216]
The Results (Infections by Site) report that urogenital-only testing would miss 80% of chlamydia and 77% of gonorrhea among the MSM studied, supporting the claim's approximate magnitude. The Results (Symptoms Associated with Infection) say men with rectal or pharyngeal infection were no more likely to report symptoms than uninfected men, but do not establish that most such infections were asymptomatic or that this explains the missed infections. The study was limited to MSM reporting a history of receptive anal intercourse. (LLM, conf=0.85)
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Sexually Transmitted Infections Treatment Guidelines, 2021
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- Authors
- Danby, C. S., Cosentino, L. A., Rabe, L. K., Priest, C. L., Damare, K. C., Macio, I. S., Meyn, L. A., Wiesenfeld, H. C., & Hillier, S. L.
- Affiliations
- University of Pittsburgh (US)
- Magee-Womens Research Institute (US)
- Corresponding author
- Danby, Claire S.
- Wiesenfeld, Harold C.
- Hillier, Sharon L.
- Venue
- Sexually Transmitted Diseases
- Published
- 2016-02
- Volume
- 43
- Issue
- 2
- Pages
- 105-109
- ISSN
- 0148-5717 (ISSN-L)
- PMC
- PMC4955797
- OpenAlex
- W2412487161
- Cited by
- 78
- References
- 35
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 4 · 2021: 10 · 2020: 14 · 2019: 12 · 2018: 7 · 2017: 8 · 2016: 4
- FWCI
- 5.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Sexually Transmitted Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Allergy and Infectious Diseases (UM1AI068633, UM1AI106707)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Keywords
- Chlamydia trachomatis, Neisseria gonorrhoeae, extragenital infection, receptive anal intercourse, men who have sex with men, women who have sex with men, pharyngeal infection, rectal infection, sexually transmitted infections
- MeSH terms
- Adolescent, Adult, Chlamydia Infections, Chlamydia trachomatis, Female, Gonorrhea, Humans, Male, Middle Aged, Neisseria gonorrhoeae, Pharynx, Prospective Studies, Surveys and Questionnaires, Rectum, Sexual Behavior, Sexually Transmitted Diseases, Vagina, Homosexuality, Male, Nucleic Acid Amplification Techniques, Young Adult
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