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Extragenital Gonorrhea and Chlamydia Among Men and Women According to Type of Sexual Exposure

Bamberger, David M. MD*†‡; Graham, Georgia MD; Dennis, Lesha BA; Gerkovich, Mary M. PhD

Sexually Transmitted Diseases: May 2019 - Volume 46 - Issue 5 - p 329–334
doi: 10.1097/OLQ.0000000000000967
Original Studies

Background Current guidelines recommend screening for extragenital gonorrhea (GC) and chlamydia (CT) only among men having sex with men (MSM). Extragenital GC and CT is associated with treatment failure and disease transmission. The prevalence of extragenital GC/CT infections in women and in men having sex with women (MSW) are less well studied. We sought to determine the prevalence of extragenital CG and CT among all persons attending a sexually transmitted diseases clinic who engaged in extragenital sexual activity.

Methods We examined demographic and clinical data of all patients who engaged in extragenital sexual activity between January 2012 and October 2014. Nucleic acid amplification testing for GC and CT was performed at sites of exposure among all men and women at pharyngeal, rectal, and urogenital sites. Multivariable logistic regression analyses were performed to determine the extent that age, race/ethnicity, and number of sexual partners predicted a positive test result.

Results Pharyngeal GC was found in 3.1% of MSW, representing 35% of the GC infections in MSW. Thirty-six percent of MSW with pharyngeal GC tested negative at their urogenital site. Pharyngeal GC in MSW prevalence was higher among those with younger age or a higher number of sex partners. Pharyngeal GC, rectal GC, and rectal CT rates were 8.5%, 15.0%, and 16.5%, respectively, among MSM and 3.8%, 4.8%, and 11.8% among women having sex with men (WSM), respectively.

Conclusions Extragenital GC and CT rates of infection was highest among MSM but was also observed in WSM and MSW, representing an unrecognized disease burden.

Extragenital gonorrhea represented a substantial portion of total cases in all men and women who engaged in extragenital sexual activity. Many would be missed without extragential screening.

From the *Department of Medicine, University of Missouri-Kansas City School of Medicine;

Kansas City, Missouri Health Department;

Department of Biomedical & Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO; and

§Department of Obstetrics/Gynecology, University of Florida, Gainesville, FL

Conflict of Interest and Sources of Funding: None declared.

Correspondence: David M. Bamberger, MD, UMKC School of Medicine, 2411 Holmes St., Kansas City, MO 64108. E-mail:

Received for publication August 13, 2018, and accepted December 16, 2018.

© Copyright 2019 American Sexually Transmitted Diseases Association