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The Case for Extragenital Screening of Chlamydia trachomatis and Neisseria gonorrhoeae in the College Health Setting

Drinkard, Lauren N. MPH; Huxta, Rebecca A. MPH; Halbritter, Ashlee MPH; Nguyen, Giang T. MD, MPH, MSCE; Malebranche, David MD, MPH

Sexually Transmitted Diseases: May 2017 - Volume 44 - Issue 5 - p 274–277
doi: 10.1097/OLQ.0000000000000593
Original Study

Background: Although the Centers for Disease Control and Prevention does not recommend routine oropharyngeal and anorectal screening for Chlamydia trachomatis and Neisseria gonorrhoeae in the general population, they do recommend it for men who have sex with men. However, risk-based extragenital screening of men may not have been adopted at all college health centers, and existing research has not focused on the college population.

Methods: We examined health records of men at a college health center in a large urban university over 6 years to evaluate effectiveness of C. trachomatis and N. gonorrhoeae screening. We also evaluated the proportion of C. trachomatis and N. gonorrhoeae infections that would have been missed if risk-based extragenital screening were not performed. Decisions to screen at extragenital sites were based on patient-reported risk behavior.

Results: For 4093 male college students screened, 7.6% of the screening visits used extragenital screening in response to self-reported risk behaviors. The case positivity rate for C. trachomatis was 3.1% with urogenital-only screening and 3.7% with risk-prompted extragenital screening. The case positivity rate for N. gonorrhoeae was 0.7% with urogenital-only screening and 3.3% with risk-prompted extragenital screening. If the college health center had relied solely on urogenital screening rather than risk-based extragenital screening, 26.4% of C. trachomatis infections and 63.2% of N. gonorrhoeae infections would have been missed.

Conclusions: One out of four C. trachomatis infections and 2 of 3 N. gonorrhoeae infections would have been missed without extragenital screening in this analysis of college men. This study reinforces Centers for Disease Control and Prevention recommendations for risk-based extragenital screening and is the first report to focus on college men. Because guidelines exist only for men, future studies should focus on extragenital screening in college women to build evidence for another group of patients that may benefit from this practice, given the high risk in young adults.

With risk-based extragenital screening of Chlamydia trachomatis and Neisseria gonorrhoeae in male college students, we identified a substantial number of cases that would have been missed using urine testing alone.

From the Student Health Service and Camps Health, University of Pennsylvania, Philadelphia, PA

Conflict of interest and sources of funding: None declared.

L.D.’s current affiliation is with Evolent Health. D.M.’s current affiliation is with WellStar Health Services, Cobb County Adult Detention Center.

Correspondence: Rebecca Huxta, MPH, Student Health Service and Campus Health, University of Pennsylvania, 3535 Market Street, Suite 100, Philadelphia, PA 19104. E-mail: rhuxta@upenn.edu.

Received for publication November 14, 2016, and accepted January 6, 2017.

© Copyright 2017 American Sexually Transmitted Diseases Association