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Standard Symptom- and Sexual History–Based Testing Misses Anorectal Chlamydia trachomatis and Neisseria gonorrhoeae Infections in Swingers and Men Who Have Sex With Men

van Liere, Geneviève A. F. S. MSc*†; Hoebe, Christian J. P. A. MD, PhD*†; Niekamp, Anne-Marie MD, MSc*†; Koedijk, Femke D. H. MSc; Dukers-Muijrers, Nicole H. T. M. PhD*†

Sexually Transmitted Diseases: April 2013 - Volume 40 - Issue 4 - p 285–289
doi: 10.1097/OLQ.0b013e31828098f8
Original Study

Background Currently, individuals at risk for sexually transmitted diseases (STDs) are tested extragenitally only if indicated, most often when there is a history of self-reported symptoms or self-reported anal sex. The sensitivity of such selective symptom- and sexual history–based testing for detection of anorectal STD has not been determined.

Methods All men having sex with men (MSM) and swingers (heterosexual couples who have sex with other heterosexual couples and their self-identified heterosexual sex partners) attending our STD clinic (consults: n = 1690) from January 2010 until February 2011 were universally tested for urogenital, anorectal, and oropharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae infections (STD). We compared STD prevalence at anorectal site based on universal versus selective testing.

Results Sensitivity of selective symptom- and sexual history–based testing for anorectal STD was 52% for homosexual MSM, 40% for bisexual MSM, 43% for bisexual male swingers, 40% for heterosexual male swingers, and 47% for female swingers.

Conclusions Universal testing of STD clinic clients who were MSM and swingers yielded more than half of all anorectal STD infections and is more sensitive for identifying anorectal STD infections compared with selective testing. Universal testing may be a more effective strategy for interrupting the ongoing transmission in high-risk sexual networks.

Universal testing of men having sex with men and swingers attending a sexually transmitted disease clinic in the Netherlands revealed that more than half of anorectal sexually transmitted diseases would be missed with standard symptom-based and sexual history–based testing.

From the *Department of Infectious Diseases, South Limburg Public Health Service, Geleen, the Netherlands; †Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; and ‡Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, Bilthoven, the Netherlands

The authors thank the staff of the Centre for Sexual Health South Limburg (STD Clinic) for their valuable contribution to the data collection and M.D. V.H. Hackert, for editing assistance.

Supported by a grant from the Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM).

This paper has been, in part, presented at the 19th International Society for Sexually Transmitted Diseases Research Congress in Quebec, July 10–13, 2011 (O1-S07.04)

The authors declare no competing interests.

This study was approved by the Medical Ethical Committee of the University of Maastricht (METC 11-4-108).

Correspondence: Geneviève A.F.S. van Liere, MSc, Department of Infectious Diseases, South Limburg Public Health Service, PO Box 2022, NL-6400 AD Heerlen, the Netherlands. E-mail:

Received for publication December 2, 2011, and accepted November 29, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association