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Extragenital Chlamydia and Gonorrhea in Young Black Men Who Have Sex With Men: Missed Treatment Opportunities for Human Immunodeficiency Virus–Infected Men Who Have Sex With Men?

Mena, Leandro, MD*; Crosby, Richard, A., PhD*†; Chamberlain, Nicholas, MD*

Sexually Transmitted Diseases: May 2018 - Volume 45 - Issue 5 - p 307–311
doi: 10.1097/OLQ.0000000000000746
Original Studies

Objectives This study of young black men who have sex with men (YBMSM) assessed the prevalence of extragenital chlamydia and gonorrhea among those testing negative for urethral infections, and compared prevalence of both by human immunodeficiency virus (HIV) status.

Methods A convenience sample of 609 YBMSM was recruited for a cross-sectional study from 2 sexual health clinics located in Jackson, MS. To detect Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), nucleic acid amplification testing was performed on urine, rectal swabs, and oral swabs. OraSure was used to detect HIV.

Results Seventy-three percent of all chlamydia infections and 77% of gonorrhea infections were found from anal and oral swabs in the absence of urethral positivity. Compared with HIV-uninfected men, HIV-infected men were significantly more likely to have pharyngeal chlamydia (P = 0.03), multiple CT infections (P = 0.02), rectal NG (P < 0.001), multiple NG infections (P = 0.04), both CT/NG rectal infections (P = 0.001).

Conclusions As much as three quarters of all chlamydia and gonorrhea infections may be missed when only urine-based nucleic acid amplification testing is used to screen YBMSM for bacterial sexually transmitted infections. These missed opportunities for diagnosis may be particularly likely among HIV-infected YBMSM.

This study of young black men who have sex with men found that 73% of all Chlamydia infections and 77% of gonorrhea infections were extragenital (no urethral positivity). Exclusive urine-based testing would miss these treatment opportunities.

From the *University of Mississippi Medical Center, Jackson, MS; and †College of Public Health at the University of Kentucky, Lexington, KY

Conflict of Interest: None declared.

Sources of Funding: This study was funded by a grant from the National Institute of Mental Health to the second author, R01MH092226.

Correspondence: Richard Crosby, PhD, College of Public Health, 111 Washington Ave, Lexington, KY 40506-0003. E-mail:

Received for publication April 13, 2017, and accepted October 15, 2017.

© Copyright 2018 American Sexually Transmitted Diseases Association