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Patterns of Extragenital Chlamydia and Gonorrhea in Women and Men Who Have Sex With Men Reporting a History of Receptive Anal Intercourse

Danby, Claire S. MD*; Cosentino, Lisa A. BS; Rabe, Lorna K. BS; Priest, Carol L. CRNP; Damare, Khrystine C. BS; Macio, Ingrid S. PA; Meyn, Leslie A. PhD; Wiesenfeld, Harold C. MDCM*; Hillier, Sharon L. PhD*†

doi: 10.1097/OLQ.0000000000000384
Original Study

Background Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in men who have sex with men is risk based. Despite high frequencies of oral and receptive anal intercourse (RAI) among women, extragenital screening is not recommended.

Methods Women (n = 175) and men who have sex with men (n = 224) primarily recruited from a sexually transmitted infection clinic reporting a lifetime history of RAI completed a structured questionnaire and clinician-collected swab samples from the rectum, pharynx, vagina (women), and urine (men). CT and GC were detected using 2 commercial nucleic acid amplification tests (Aptima Combo 2; Hologic, Inc, Bedford, MA; Xpert CT/NG, Cepheid Innovation, Sunnyvale, CA).

Results The median age of the population was 26 years, 62% were white, and 88% were enrolled from a sexually transmitted disease clinic. Men were more likely than women to have GC (22.8% vs. 3.4%) and CT (21.9% vs. 12.6%). In men versus women, GC was detected in 16.5% versus 2.3% of pharyngeal swabs, 11.6% versus 2.3% of rectal swabs, and 5.4% versus 2.9% of urine samples or vaginal swabs. C. trachomatis was detected in 2.2% versus 1.7% of pharyngeal swabs, 17.4% versus 11.4% of rectal swabs, and 4.5% versus 10.3% for urogenital sites in men versus women. Overall 79.6% of CT and 76.5% of GC in men and 18.2% of CT and 16.7% of GC in women were detected only in the pharynx or rectum.

Conclusion Reliance on urogenital screening alone misses most of GC and CT in men and more than 15% of infections in women reporting RAI.

Among people reporting a lifetime history of anal receptive intercourse, sexually transmitted infections are detected only at extragenital sites in up to 80% of men and 17% of women.

From the *University of Pittsburgh, Pittsburgh, PA; and †Magee-Womens Research Institute, Pittsburgh, PA.

Conflict of interest: None declared.

Received for publication June 26, 2015, and accepted October 22, 2015.

© Copyright 2016 American Sexually Transmitted Diseases Association