Performance of 4 Molecular Assays for Detection of Chlamydia and Gonorrhea in a Sample of Human Immunodeficiency Virus-Positive Men Who Have Sex With Men

Abstract

Background Nucleic acid amplification testing (NAAT) is the preferred method to detect Chlamydia trachomatis and Neisseria gonorrhoeae, but information regarding performance of currently available assays is needed. This study evaluated the performance of the Aptima Combo 2, GeneXpert, cobas4800, and ProbeTec QX (CTQ/GCQ) to detect chlamydia and gonorrhea in pharyngeal, rectal, and urine specimen. Methods Adult male patients seen at an urban human immunodeficiency virus clinic in Birmingham, Alabama who reported sex with men (men who have sex with men) and no antibiotic use in the past 30 days were enrolled between November 2014 and December 2016. Following a baseline survey, rectal and initial void urine specimens were self-collected. A composite infection standard was used, where 1 assay was compared with 3 others to determine sensitivity and specificity estimates for rectal and urine samples. Two pharyngeal samples were clinician-collected for chlamydia and gonorrhea testing and both had to be positive to be considered a true positive. Results Among the 181 men enrolled into the study, 15.5% and 7.2% had at least 1 positive chlamydia and gonorrhea result at any site, respectively. Among all 4 assays, chlamydia sensitivity rates ranged from 82% to 96% among rectal samples. Rectal gonorrhea sensitivity estimates ranged from 67% to 99%. The GCQ assay was less sensitive in detecting rectal gonorrhea compared with the other assays (P = 0.02). Conclusions More than 80% of chlamydia and gonorrhea infections would have been missed with urine-only screening, highlighting the importance in using NAATs to detect chlamydia and gonorrhea infections among men who have sex with men.

High Prevalence of Sexually Transmitted Infections and Risk Factors Among HIV-Positive Individuals in Yunnan, China

“…The prevalence of CT detected in the two groups of participants (3.4% vs 3.0%) was larger than the 0.9% identi ed in WLHA [20], while it was smaller than the 11.1% of MSM in Port-au-Prince [31]. The prevalence of NG identi ed in our study (3.4% vs 0.5%) was lower than the 5.4% observed in WLHA [20] and the 7.2% of HIV-positive MSM in Birmingham [32].…”

Chlamydia trachomatis transmission between the oropharynx, urethra and anorectum in men who have sex with men: a mathematical model

“…The proportion of MSM who had more than one anatomical site infected with chlamydia was 20.0% (124/ 620). We also identified five similar studies reported multisite infections of chlamydia using NAAT as the validation data sets, including one study in Australia [40], two studies in the USA [41,42], one study in the Netherlands [21] and one study in Thailand [22]. (Additional file 2: Table S5).…”

Role of saliva use during masturbation in the transmission of Chlamydia trachomatis in men who have sex with men

“…Furthermore, adding masturbation in the model did not significantly alter the relative proportions of chlamydia incidence at the oropharynx, urethra and anorectum. These results may explain the epidemiological data suggesting why oropharyngeal chlamydia is not common [8, 17, 18, 20, 28].…”

“…We identified five available studies with single-site infection and multisite infection of C. trachomatis using nucleic acid amplification test (NAAT) from four countries: (1) 4888 MSM attending Melbourne Sexual Health Centre in 2018 and 2019 [16]; (2) MSM surveillance data (271 242 consultations) from all STI clinics in the Netherlands in 2008–2017 [17]; (3) a community sample of 1610 MSM in Thailand in 2015–2016 [18]; (4) 393 MSM attending STD & HIV care clinics in the USA in 2016–2017 (Pol BVD) [19]; and (5) 179 MSM with HIV in the USA in 2014–2016 [20] (see Supplementary Table S1).…”