Extragenital Screening Is Essential for Comprehensive Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in the Pediatric Population

Abstract

Chlamydia trachomatis and Neisseria gonorrhoeae are the two most common causes of sexually transmitted disease in the United States. Studies in adults, mostly in men who have sex with men, have shown that the prevalence of C. trachomatis and N. gonorrhoeae infections is much higher in extragenital sources compared to urogenital sources. A similar large sample of data on the burden of C. trachomatis and N. gonorrhoeae infections by anatomic site is lacking in children. We retrospectively analyzed data from 655 patients tested for C. trachomatis (887 specimens) and N. gonorrhoeae (890 specimens) at the Children’s Hospital of Philadelphia. We restricted the analysis to include patients between 2 and 17 years of age that had all three sources (urine, oropharynx, and rectum) collected at the same visit. The final data set included specimens from all three sources from 148 and 154 patients for C. trachomatis and N. gonorrhoeae, respectively. Specimens were tested for C. trachomatis and N. gonorrhoeae using a Gen-Probe Aptima Combo 2 assay. The burden of C. trachomatis and N. gonorrhoeae infection was significantly higher in the 14- to 17-year age group (24.7%, P = 0.041; 25.8%; P = 0.001) compared to the 10- to 13-year (5.9%; 5.6%), 6- to 9-year (4.6%; 4.6%), and 2- to 5-year (8.3%; 0%) age groups, respectively. The positivity rate for C. trachomatis was highest for rectal (16.2%), followed by urine (5.4%) and oropharyngeal (0.7%) sites. The positivity rate for N. gonorrhoeae was highest for rectal sites (10.4%), followed by oropharyngeal (9.7%) and urine (1.9%) sites. The source with highest diagnostic yield is rectum for C. trachomatis and rectum and oropharynx for N. gonorrhoeae. Hence, extragenital screening is critical for the comprehensive detection of C. trachomatis and N. gonorrhoeae in the pediatric population.

Visual and rapid identification of Chlamydia trachomatis and Neisseria gonorrhoeae using multiplex loop-mediated isothermal amplification and a gold nanoparticle-based lateral flow biosensor

“…Various laboratory diagnostic approaches have recently been used to test chlamydia and gonorrhea and have changed considerably (Uprety and Cardenas, 2019;Adamson et al, 2020;Adamson and Klausner, 2022) Amplification time optimization for the mLAMP-AuNPs-LFB assay Four LAMP reaction times were evaluated at 67°C: (A) 15 min, (B) 25 min, (C) 35 min, and (D) 45 min. AuNPs-LFBs 1-7 represent nucleic acid template levels 5.0×10 4 , 5.0×10 3 , 5.0×10 2 , 5.0×10 1 , 5.0×10 0 , and 5.0×10 -1 copies and negative control (DW), respectively.…”

“…They are strongly associated with orchitis, prostatitis, epididymitis, and urethritis in males (Wilkinson et al, 2021). Infections may result in pelvic inflammatory illness, salpingitis, ectopic pregnancy, and infertility in females (Uprety and Cardenas, 2019;Herzog et al, 2012). Fetal infection, premature delivery, stillbirth, low birth weight, and miscarriage can arise during pregnancy with infected mothers (Gaydos et al, 2019;Niles et al, 2021).…”

Preferences for Rectal STI Sample Collection and Sexual Behaviors Among Adolescent and Young Adult Women Accessing Primary Care Services

“…I ncreasing recognition of asymptomatic rectal chlamydia and gonorrhea (CT/NG) among women [1][2][3][4] led to changes in the 2021 national screening guidelines to recommend clinicians consider screening after discussing sexual behaviors and screening for rectal CT/NG with their adolescent and adult female patients. 5 These discussions may increase the rate of testing for rectal STIs and case finding in primary care settings among AYA women.…”