Urine-Based Asymptomatic Urethral Gonorrhea and Chlamydia Screening and Sexual Risk-Taking Behavior in Men Who Have Sex with Men in Greater Boston

Abstract

To assess the prevalence of asymptomatic urethral gonorrhea and chlamydia men who have sex with men (MSM) living in greater Boston, 206 men attending routine medical appointments consented to urine-based chlamydia and gonorrhea screening using urine LCR amplification. Of those screened, 201 patients also completed a seven-question survey to assess sexual risk behaviors associated with urethral sexually transmitted infections. Less than 1% of the asymptomatic patients screened tested positive for urethral chlamydia; none tested positive for urethral gonorrhea. Forty-eight percent reported multiple sexual partners in the 30 days prior to screening, with HIV-infected patients reporting fewer partners and less unprotected insertive anal sex than HIV-uninfected patients. Almost 25% of patients screened used the Internet in the 30 days prior to screening to find a sexual partner. Internet use was associated with increased numbers of sexual partners in the 30 days prior to screening. Findings suggest that asymptomatic urethral chlamydia and gonorrhea may be uncommon in MSM living in the greater Boston area and that the recent rise in the prevalence of sexually transmitted infections may not be due to untreated asymptomatic infections. Increased awareness of STD symptoms among patients and medical providers is critical to timely diagnosis and treatment of STDs in MSM.

Internet and Email Use Among STD Clinic Patients

“…Numerous studies have found that using the Internet to find sex partners is common among MSM1–5, 7–9, and several have associated syphilis or HIV acquisition in that population with use of the Internet1, 8, 20. On the other hand, a recent analysis found that heterosexuals who used the Internet to find partners were at lower risk for STDs than other heterosexual STD clinic patients21, highlighting the complexity of how the Internet may affect STD risk and transmission dynamics.…”

“…Although much has been written about the role of the Internet in the spread of STDs1–9, relatively less has been written about the Internet in general, or email in particular, as a tool in the prevention of STDs7, 10–14. Concerns of persons considering using the Internet for health information include the quality of information available online, privacy concerns, and access to the Internet12, 15.…”

Asymptomatic Sexually Transmitted Infections in HIV-Infected Men Who Have Sex with Men: Prevalence, Incidence, Predictors, and Screening Strategies

“…The relative scarcity of asymptomatic urethral STIs in MSM was also recently shown in a study from the greater Boston area reporting a prevalence rate of asymptomatic urethral STIs of less than 1% among MSM. 13 Longitudinal studies of incident asymptomatic STIs are relevant since cross-sectional studies do not identify newly acquired infections and it has been shown that NG and CT can persist in asymptomatic individuals for many months, with such individuals being persistent reservoirs of infection. 14 In the current study, incident infections were diagnosed in more than 1 in 10 patients.…”

High prevalence of extra-genital chlamydial or gonococcal infections among men who have sex with men and transgender women in Lima, Peru

“…gonorrhoeae assay (Hologic, San Diego, CA, USA). Because the frequency of asymptomatic urethral infection in males is low (some studies indicating less than 1%), 7 we decided not to routinely screen participants for asymptomatic urethral infection. Participants found to be infected were treated according to Peruvian national guidelines.…”