Value of screening for oro-pharyngeal Chlamydia trachomatis infection.

Abstract

Aims-To determine whether oro-pharyngeal colonisation by Chlamydia trachomatis occurs in patients at risk of genital chlamydia infection; to determine whether screening pharyngeal specimens by polymerase chain reaction (PCR) increases detection of C trachomatis compared with isolation and the immune dot blot test; and to correlate the detection of C trachomatis and Neisseria gonorrhoeae in the pharynx with a history oforo-genital contact.Methods-Thirteen homosexuals and 11 heterosexuals were included in the study.Urogenital and pharyngeal specimens were tested for C trachomatis and N gonorrhoeae using standard clinical diagnostic procedures. Two different PCR methodologies were also used to detect C trachomatis in the pharyngeal specimens. Results were correlated with the mode of sexual practice. Results-Oro-genital sexual contact was practised by 64*9% (72/111) of heterosexuals in addition to penetrative penovaginal intercourse. Additionally, 62-1% (77/124) of all patients did not use any form of barrier protection. Of those who admitted to oro-genital sexual contact, 17*6% ofpatients with a genital chlamydial infection and 36-4% of those with genital gonorrhoea also had asymptomatic pharyngeal colonisation. C trachomatis was detected in three of 124 (2-4%) pharyngeal specimens by PCR which were reported as negative by chlamydial culture; one was positive by the immune dot blot test. Conclusion-The majority of patients practised unprotected oro-genital contact and significant pharyngeal colonisation by C trachomatis and N gonorrhoeae occurred if genital infection was present. Despite the use of PCR in a population at high risk of sexually transmitted disease, the prevalence ofchlamydia in the pharynx was very low. This indicates that transmission of C trachomatis to the oropharynx does not pose a serious health risk and that screening of patients for oropharyngeal C trachomatis is not worthwhile. (J Clin Pathol 1995;48:658-

Spontaneous pharyngealChlamydia trachomatisRNA clearance. A cross-sectional study followed by a cohort study of untreated STI clinic patients in Amsterdam, The Netherlands

“…Testing for PhCT in various STI clinic populations using a nucleic acid amplification test (NAAT) revealed a PhCT prevalence between 1% and 3% 7 8. Although one study showed an association between upper respiratory tract symptoms and PhCT,9 most patients with PhCT are asymptomatic 8 10 11. Recently, acquisition of urethral chlamydia through fellatio has been reported in heterosexual males and MSM 12 13.…”

Sex differences in tonsillitis

“…A 1995 study of the value of screening for oropharyngeal Chlamydia trachomatis found that the prevalence of this bacterium was very low, did not pose a serious health risk and hence was not worthwhile 14 . Another 1994 study found that the rate of genital mycoplasma isolation was significantly higher in children with recurrent adenotonsillitis (34.5%) than in those with obstructive symptoms (3.7%).…”

Increased Sensitivity of DNA Amplification Testing for the Detection of Pharyngeal Gonorrhea in Men Who Have Sex with Men

“…All cases of pharyngeal N. gonorrhoeae that were detected in a study from Great Britain were asymptomatic [14]. In another study, which was conducted in Seattle, 84% of individuals who had pharyngeal N. gonorrhoeae infection had no symptoms [11].…”