Evaluation of sexual history-based screening of anatomic sites for chlamydia trachomatis and neisseria gonorrhoeae infection in men having sex with men in routine practice

Abstract

BackgroundSexually transmitted infection (STI) screening programmes are implemented in many countries to decrease burden of STI and to improve sexual health. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae has a prominent role in these protocols. Most of the screening programmes concerning men having sex with men (MSM) are based on opportunistic urethral testing. In The Netherlands, a history-based approach is used. The aim of this study is to evaluate the protocol of screening anatomic sites for C. trachomatis and N. gonorrhoeae infection based on sexual history in MSM in routine practice in The Netherlands.MethodsAll MSM visiting the clinic for STI in The Hague are routinely asked about their sexual practice during consulting. As per protocol, tests for urogenital, oropharyngeal and anorectal infection are obtained based on reported site(s) of sexual contact. All consultations are entered into a database as part of the national STI monitoring system. Data of an 18 months period were retrieved from this database and analysed.ResultsA total of 1455 consultations in MSM were registered during the study period. The prevalence of C. trachomatis and N. gonorrhoeae per anatomic site was: urethral infection 4.0% respectively and 2.8%, oropharynx 1.5% and 4.2%, and anorectum 8.2% and 6.0%. The majority of chlamydia cases (72%) involved a single anatomic site, which was especially manifest for anorectal infections (79%), while 42% of gonorrhoea cases were single site. Twenty-six percent of MSM with anorectal chlamydia and 17% with anorectal gonorrhoea reported symptoms of proctitis; none of the oropharyngeal infections were symptomatic. Most cases of anorectal infection (83%) and oropharyngeal infection (100%) would have remained undiagnosed with a symptom-based protocol.ConclusionsThe current strategy of sexual-history based screening of multiple anatomic sites for chlamydia and gonorrhoea in MSM is a useful and valid guideline which is to be preferred over a symptom-based screening protocol.

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…A substantial proportion of extra-genital infections (70-90% of rectal and 95-100% of pharyngeal) are asymptomatic (46,82,83). Many pharyngeal infections are restricted to the pharynx (46,84,85). Pharyngeal gonorrhoea has a high incidence: prevalence ratio, suggesting spontaneous resolution (86,87), in contrast to pharyngeal chlamydia, where a high prevalence: incidence ratio supports longer lived infection.…”

“…A substantial proportion of extra-genital infections (70-90% of rectal and 95-100% of pharyngeal) are asymptomatic (46,82,83). Many pharyngeal infections are restricted to the pharynx (46,84,85).…”

Defizite in den Angeboten zur STI-Diagnostik für Männer mit gleichgeschlechtlichen Sexualkontakten in deutschsprachigen Städten

“…Ein erheblicher Teil dieser Infektionen verläuft bei MSM asymptomatisch oder mit nur gering ausgeprägten Symptomen, und Infektionen sind in höherem Ausmaß als bei Heterosexuellen in verschiedenen Körperregionen lokalisiert. Während Penis und Genitalregion bei heterosexuellen Männern den dominierenden Lokalisationsort für sexuell übertragene Infektionen darstellen, sind bei MSM mindestens ebenso häufig oder häufiger sexuell übertragbare Infektionen im Analbereich, im Rektum und im Rachen lokalisiert [6].…”

Proctite e Infeção Anoretal por Chlamydia trachomatis e Neisseria gonorrhoeae em HSH – Estudo Retrospetivo

“…3,4 Um número considerável destas infecções anoretais são assintomáticas mas, tal como as outras IST, facilitam a aquisição e transmissão do VIH. 5,6 A pesquisa da infecção por CT ou NG nos homens é normalmente efectuada na urina ou no exsudado uretral. Porém, durante a última década, vários estudos têm demonstrado a importância de realizar colheitas orofaríngeas e anoretais na população de HSH, 5 pelo que o CDC (Centers for Disease Control and Prevention) recomenda atualmente o rastreio da infeção anoretal por NG e CT nos HSH com antecedentes de sexo anal recetivo no último ano.…”

“…5,6 A pesquisa da infecção por CT ou NG nos homens é normalmente efectuada na urina ou no exsudado uretral. Porém, durante a última década, vários estudos têm demonstrado a importância de realizar colheitas orofaríngeas e anoretais na população de HSH, 5 pelo que o CDC (Centers for Disease Control and Prevention) recomenda atualmente o rastreio da infeção anoretal por NG e CT nos HSH com antecedentes de sexo anal recetivo no último ano. 4 O presente estudo retrospetivo pretende avaliar e caracterizar do ponto de vista sociodemográfico, comportamental, clínico e laboratorial os casos de proctite e infecção anoretal por NG e CT em HSH que recorreram à consulta de DST (Doenças Sexualmente Transmissíveis) do Centro de Saúde (CS) da Lapa, entre janeiro de 2008 e dezembro de 2013.…”