Extragenital Chlamydia and Gonorrhea Among Community Venue–Attending Men Who Have Sex with Men — Five Cities, United States, 2017

Abstract

Sexually transmitted diseases (STDs) disproportionately affect gay, bisexual, and other men who have sex with men (MSM) in the United States ( 1 ). Because chlamydia and gonorrhea at extragenital (rectal and pharyngeal) anatomic sites are often asymptomatic, these anatomic sites serve as a reservoir of infection, which might contribute to gonococcal antimicrobial resistance ( 2 ) and increased risk for human immunodeficiency virus (HIV) transmission and acquisition ( 3 ). To ascertain prevalence of extragenital STDs, MSM attending community venues were recruited in five U.S. cities to provide self-collected swabs for chlamydia and gonorrhea screening as part of National HIV Behavioral Surveillance (NHBS). Overall, 2,075 MSM provided specimens with valid results, and 13.3% of participants were infected with at least one of the two pathogens in at least one of these two extragenital anatomic sites. Approximately one third of participating MSM had not been screened for STDs in the previous 12 months. MSM attending community venues had a high prevalence of asymptomatic extragenital STDs. The findings underscore the importance of sexually active MSM following current recommendations for STD screening at all exposed anatomic sites at least annually ( 4 ).

The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission

“…Several studies have compared the prevalence of extragenital gonorrhoea and chlamydia in MSM by HIV status. A US study reported that HIV‐positive MSM had a higher prevalence of anorectal gonorrhoea (8.2% vs. 3.3%) and anorectal chlamydia (9.0% vs. 6.6%) than HIV‐negative MSM; however, the prevalence was similar in both groups for oropharyngeal infection (that is oropharyngeal gonorrhoea: 5.2% in HIV‐positive vs. 4.3% in HIV‐negative; oropharyngeal chlamydia: 1.6% in HIV‐positive vs. 1.3% in HIV‐negative) . These findings are consistent with another study conducted in Melbourne, Australia, showing that the prevalence of anorectal gonorrhoea was higher in HIV‐positive MSM (15.4%) than in HIV‐negative MSM (7.3%) but the prevalence of oropharyngeal gonorrhoea was similar in both in HIV‐positive MSM (9.9%) and HIV‐negative MSM (8.1%) .…”

“…Both gonorrhoea and chlamydia until recently were thought to be mainly transmitted through condomless penetrative intercourse such as penile‐vaginal, penile‐anal and oral sex . However, in the context of rising STI rates and ineffective interventions, it is important to review the transmission of both infections particularly at extragenital sites in MSM which are largely asymptomatic .…”

Optimizing Coverage vs Frequency for Sexually Transmitted Infection Screening of Men Who Have Sex With Men

“…Routine STI screening among MSM remains suboptimal, particularly at extragenital (pharynx and rectum) sites, where STIs are frequently asymptomatic [6–9, 12]. A recent venue-based study estimated that 1 in 8 MSM had prevalent extragenital NG or CT infection and one-third reported not having been tested for STIs in the past 12 months, suggesting that high-risk MSM were not being screened per CDC recommendations [10]. Behavioral risk is estimated to have little impact on STI screening frequency, with the screening rate increasing only 1.4% per additional anal sex partner in 1 national study [22].…”

“…These infections can be effectively diagnosed and treated at all sites of sexual exposure, but screening has focused on urogenital testing [6–8]. Asymptomatic infections, particularly rectal, that contribute to ongoing STI transmission are often missed unless detected through routine screening [9, 10].…”

Increasing Sexually Transmitted Infections in the U.S.: A Call for Action for Research, Clinical, and Public Health Practice

“…Culture detection is available for testing at extragenital sites, but the nucleic acid amplification test (NAAT) is more sensitive than cell cultures and is the preferred method for laboratory detection of chlamydia and gonorrhea. Extragenital screening using NAAT is available at many local, state, and commercial laboratories and is approved by the Food and Drug Administration (Centers for Disease Control and Prevention, 2009;Johnson Jones et al, 2019;U.S. Food and Drug Administration, 2019).…”