Extragenital Infections Caused byChlamydia trachomatisandNeisseria gonorrhoeae: A Review of the Literature

Abstract

In the United States, sexually transmitted diseases due to Chlamydia trachomatis and Neisseria gonorrhoeae continue to be a major public health burden. Screening of extragenital sites including the oropharynx and rectum is an emerging practice based on recent studies highlighting the prevalence of infection at these sites. We reviewed studies reporting the prevalence of extragenital infections in women, men who have sex with men (MSM), and men who have sex only with women (MSW), including distribution by anatomical site. Among women, prevalence was found to be 0.6–35.8% for rectal gonorrhea (median reported prevalence 1.9%), 0–29.6% for pharyngeal gonorrhea (median 2.1%), 2.0–77.3% for rectal chlamydia (median 8.7%), and 0.2–3.2% for pharyngeal chlamydia (median 1.7%). Among MSM, prevalence was found to be 0.2–24.0% for rectal gonorrhea (median 5.9%), 0.5–16.5% for pharyngeal gonorrhea (median 4.6%), 2.1–23.0% for rectal chlamydia (median 8.9%), and 0–3.6% for pharyngeal chlamydia (median 1.7%). Among MSW, the prevalence was found to be 0–5.7% for rectal gonorrhea (median 3.4%), 0.4–15.5% for pharyngeal gonorrhea (median 2.2%), 0–11.8% for rectal chlamydia (median 7.7%), and 0–22.0% for pharyngeal chlamydia (median 1.6%). Extragenital infections are often asymptomatic and found in the absence of reported risk behaviors, such as receptive anal and oral intercourse. We discuss current clinical recommendations and future directions for research.

Detection of Chlamydia trachomatis in rectal specimens in women and its association with anal intercourse: a systematic review and meta-analysis

“…A non-systematic review of the literature on extragenital infections showed similar findings for rectal CT positivity and also highlighted that extragenital infections are often found in the absence of reported risk behaviours such as AI 6. However, the authors did not calculate an estimate for concurrent urogenital CT or RR for AI and rectal CT.…”

High prevalence of curable sexually transmitted infections among pregnant women in a rural county hospital in Kilifi, Kenya

“…Unfortunately, our hygiene question did not distinguish urinating from defecating, or inquired whether the cleaning mode included both anus and vagina. It is possible that such cleaning transported bacteria from the perianal area to the vagina, as pathogens causing curable STIs may be found in paragenital areas [43]. Moreover, there is a strong correspondence in bacterial species and loads between the vagina and rectum of pregnant women [44].…”

Missed Opportunities of Chlamydia and Gonorrhea Detection When Not Using Extra Genital Screening Among Males

“…This would have been based on a false assumption that among those who tested positive for GC infection, that patients were also tested for CT infection (8) . Other researchers have reported similar findings stating that if a clinic does not perform extra screening measures, then roughly 70% of CT/GC cases, would have gone unreported (16)(17) .…”

“…Performing urethral screening alone creates the opportunity for missed infections in other anatomical sites. Health Departments and STD Clinics should continue to perform extra genital screening of all three anatomical sites as there is limited data at the national level, underestimation of disease prevalence, and risk for HIV (16)(17) . STD screening guidelines should continue to be followed to reduce incidence of new cases.…”