Extragenital Gonorrhea and Chlamydia Positivity and the Potential for Missed Extragenital Gonorrhea With Concurrent Urethral Chlamydia Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics—Sexually Transmitted Disease Surveillance Network, 2015–2019

Abara, Winston E.; Llata, Eloisa; Schumacher, Christina; Carlos-Henderson, Juli; Peralta, Angela M; Huspeni, Dawn; Kerani, Roxanne P.; Elder, Heather; Toevs, Kim; Pathela, Preeti; Asbel, Lenore; Nguyen, Trang; Bernstein, Kyle T.; Torrone, Elizabeth; Kirkcaldy, Robert D.

doi:10.1097/olq.0000000000001170

Cited by 30 publications

(45 citation statements)

References 17 publications

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“…Many oropharyngeal bacterial STIs such as NG and CT are often asymptomatic [48][49][50][51] and estimates of their prevalence is limited by insufficient testing [52][53][54]. Our overall prevalence of oropharyngeal STIs was 7%, 5% for NG and 2% for CT which is consistent with estimates from higher-income countries.…”

Section: Plos Onesupporting

confidence: 84%

Oral sex practices among men who have sex with men and transgender women at risk for and living with HIV in Nigeria

et al. 2020

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Background Men who have sex with men (MSM) and transgender women (TGW) are at risk for sexually transmitted infections (STIs), including those of the oropharynx. We estimated the prevalence and factors associated with oral sex practices and characterized oropharyngeal STIs among a cohort of MSM and TGW in Nigeria. Methods From 2013 to 2018, TRUST/RV368 recruited MSM and TGW into HIV/STI diagnosis and treatment at community-based clinics in Nigeria. Participants who completed HIV testing and oral sex questions at enrollment were selected. Cross-sectional analyses with bivariate and multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs). Oropharyngeal swab testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) began in 2014 and for those with diagnostic results at enrollment, the unadjusted association of oral sex practices with oropharyngeal STIs was conducted. Results A total of 1342 participants had a median age of 25 years (interquartile range: 22-29), 58% were living with HIV, and 69% reported oral sex practices. Factors associated with increased odds of engaging in oral sex included living with HIV (adjusted [a]

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Section: Plos Onesupporting

confidence: 84%

Oral sex practices among men who have sex with men and transgender women at risk for and living with HIV in Nigeria

et al. 2020

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“…However, many pharyngeal and rectal CT and NG cases go undiagnosed and more importantly untreated because of their asymptomatic nature and lower screening rates 2–6 13–16. Previous studies have demonstrated that screening for urogenital CT/NG alone among MSM may miss a substantial amount (14%–85%) of CT/NG cases 6 13 17–22. In other words, a negative urogenital test for CT/NG may miss positive CT/NG cases at the pharyngeal and rectal sites had urogenital testing alone been performed.…”

Section: Introductionmentioning

confidence: 99%

High proportions of rectal and pharyngeal chlamydia and gonorrhoea cases among cisgender men are missed using current CDC screening recommendations

Assaf

Cunningham

Adamson³

et al. 2022

Sex Transm Infect

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ObjectivesPharyngeal and rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are often undiagnosed due to their asymptomatic nature. This study aims to determine (1) the prevalence of CT/NG infections by anatomical site among cisgender men; (2) the proportion of missed CT/NG rectal/pharyngeal infections if urogenital testing alone was performed or screening depended on self-reported behaviour alone; and (3) the predictive probability of self-reported behaviours for rectal CT/NG.MethodsThis cross-sectional study used electronic health records collected at a sexual health clinic in Los Angeles from 18 November 2018 until 28 February 2020. The included patients were ≥18 years of age cisgender men who received CT/NG testing at least once during the study period. We calculated the proportion of missed pharyngeal/rectal CT/NG infections if only urogenital testing had been done and if testing was based only on self-reported anal sex. Separately, we ran logistic regressions for predictive probability of self-reported anal sex on CT/NG rectal infections.ResultsOverall, there were 13 476 unique patients with 26 579 visits. The prevalence of any extragenital CT/NG infection was 37.28%. Over 80% rectal/pharyngeal CT cases and over 65% rectal/pharyngeal NG cases would be missed if urogenital testing alone was performed. Likewise, over 35% rectal CT/NG cases would be missed had testing relied on self-reported sexual behaviours alone.ConclusionsThe proportion of missed rectal and pharyngeal CT/NG infections is high. Our data from a sexual health clinic lend support to three-site opt-out testing for cisgender men attending a sexual health/Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ+) specialty clinic regardless of their sexual orientation or reported sexual behaviours.

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“…20,25,26 In a study of over 77,000 adult MSM in the Sexually Transmitted Diseases Surveillance Network, 75% of extragenital GC and 89% of extragenital CT infections were associated with negative urethral tests. 23 To our knowledge, our study presents the largest database of co-STIs in AYAs with HIV in the US and provides unique insight into the behaviors and distribution of co-infections in this group, highlighting important implications for screening practices. Because the most frequent presentation of GC and CT in our study was asymptomatic extragenital infection, the majority would have been missed without routine screening at all anatomic sites.…”

Section: Discussionmentioning

confidence: 91%

Incidence, Reinfection, and Discrepancy Between Sexual Practice and Anatomic Site Positivity of Sexually Transmitted Infections in Youth With HIV

Loerinc

Scheel

Jordan-Thompson

et al. 2021

Pediatric Infectious Disease Journal

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Background: This study aimed to determine the overall incidence and reinfection rates of sexually transmitted infections (STIs) and the discrepancy between self-reported exposure history and anatomic site positivity of STIs among adolescents and young adults (AYAs) with HIV in Atlanta, GA. Methods: Retrospective chart review was conducted on all patients 13-24 years of age at the Grady Ponce and Family Youth Clinic from January 1, 2009 to December 31, 2018. Data were collected on patient demographics, self-reported sexual history and STI events. First STI incidence and incidence of reinfections were calculated by dividing new cases over corresponding person follow-up time. Results: A total of 626 sexually active AYAs with HIV were included in analysis. The mean age at first observation was 18.9 (SD: ±2.8) years; 72% were male, 92% were Black and 80% were horizontally infected. The cumulative first STI incidence rate was 45.49 cases per 100 person-years, and the recurrent STI incidence rate was 119.86 cases per 100 person-years. Among all Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) cases, the most common site of infection was the rectum (48.6% and 49.6%, respectively). Disagreement between exposure history and presence of GC or CT infection was statistically significant for nearly all anatomic sites and types of intercourse. Conclusions: AYAs with HIV in Atlanta have disproportionately high first and recurrent incidence rates of STIs, with many patients not reporting exposure at their site of infection. There is considerable need to increase screening for STIs, including routine extragenital testing for GC and CT, among AYAs with HIV regardless of self-reported exposure history.

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Extragenital Gonorrhea and Chlamydia Positivity and the Potential for Missed Extragenital Gonorrhea With Concurrent Urethral Chlamydia Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics—Sexually Transmitted Disease Surveillance Network, 2015–2019

Cited by 30 publications

References 17 publications

Oral sex practices among men who have sex with men and transgender women at risk for and living with HIV in Nigeria

Oral sex practices among men who have sex with men and transgender women at risk for and living with HIV in Nigeria

High proportions of rectal and pharyngeal chlamydia and gonorrhoea cases among cisgender men are missed using current CDC screening recommendations

Incidence, Reinfection, and Discrepancy Between Sexual Practice and Anatomic Site Positivity of Sexually Transmitted Infections in Youth With HIV

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