<i>Chlamydia trachomatis</i>and<i>Neisseria gonorrhoeae</i>Transmission from the Oropharynx to the Urethra among Men Who Have Sex with Men

Bernstein, Kyle T.; Stephens, Sally C.; Barry, Pennan M.; Kohn, Robert; Philip, Susan; Liska, Sally; Klausner, Jeffrey D.

doi:10.1086/648427

Cited by 104 publications

(64 citation statements)

References 11 publications

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“…Infection of the urethra with chlamydia and gonorrhoea is also common in MSM, and is associated with a history of penetrative oral and anal sex, but prevalence has been found at similar levels in men reporting only oro-insertive sex (90). A recent retrospective Australian study suggested oral sex to be significantly associated with urethral gonorrhoea infection (and primary syphilis), but urethral chlamydia was more strongly associated with anal sex (91).…”

Section: Chlamydia and Gonorrhoeamentioning

confidence: 99%

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

et al. 2018

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This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG’s document ‘Framework for guideline development and assessment’ published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for ‘Identification of problematic recreational drug and alcohol use’ section and ‘Sexual problems and dysfunctions in MSM’ section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years’ time, 2022.

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Section: Chlamydia and Gonorrhoeamentioning

confidence: 99%

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

et al. 2018

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“…Marcus et al reported that of 227 heterosexual men whose only urethral exposure was fellatio in the prior 3 months, 8 (3.5%) had urethral CT detected by urine TMA [28]. Similarly, Bernstein et al reported that of 397 MSM whose only urethral exposure was fellatio in the prior 3 months, 19 (4.8%) had urethral CT detected by urine TMA, and urethral CT positivity was higher in human immunodeficiency virus-infected individuals (16% vs 3%) [29]. Both studies enrolled patients from a San Francisco STD clinic among whom condom use was very rare.…”

Section: Discussionmentioning

confidence: 97%

“…Studies suggest that OP CT is transmissible to genital sites [28,29], which justifies treating patients who have OP CT detected, irrespective of presence of symptoms. However, because studies have demonstrated that OP CT prevalence is very low with routine OP CT screening, routine OP CT screening is not justified in most clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of UncomplicatedChlamydia trachomatisInfections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

Geisler

2015

Clin Infect Dis.

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In preparation for the 2015 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases (STD) Treatment Guidelines, the CDC convened an advisory group in 2013 to examine recent abstracts and published literature addressing the epidemiology, diagnosis, and management of STDs. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of uncomplicated Chlamydia trachomatis (CT) infection in adolescents and adults that were considered in development of the 2015 CDC STD Treatment Guidelines. The evidence reviewed primarily focused on CT infection risk factors in women, clinical significance of oropharyngeal CT detection, acceptability and performance of CT testing on self-collected specimens in men, performance of CT point-of-care tests, efficacy of recommended and investigational CT infection treatments, and timing of test of cure following CT infection treatment in pregnant women.Keywords. chlamydia; diagnosis; management; CDC; guidelines.Chlamydia trachomatis (CT) infection is the most frequently reported bacterial sexually transmitted infection in the United States and remains highly prevalent, with >1.4 million cases reported to the Centers for Disease Control and Prevention (CDC) annually [1]. Young age is a strong predictor of CT infection, with the highest CT infection prevalence in persons <25 years of age [1]. Because the majority of CT infections are asymptomatic, detection of infection often relies on screening. The 2010 CDC Sexually Transmitted Diseases (STD) Treatment Guidelines recommends annual CT screening in all sexually active women 25 years of age or younger and also older women with risk factors (eg, those who have a new sex partner or multiple sex partners) [2]. Benefits of CT screening in women have been demonstrated in areas where screening programs have reduced rates of pelvic inflammatory disease (PID) [3,4], a precursor of infertility, and recent literature suggests a continued decline in PID rates in the United States [5].The approach to the diagnosis and management of uncomplicated CT infection in adolescents and adults includes (1) CT testing using nucleic acid amplification tests (NAATs); (2) treatment with CDC-recommended therapy to reduce complications and prevent transmission to others; (3) treatment of sexual partners to prevent reinfection of patients and complications in patients and partners; (4) risk-reduction counseling; (5) repeat CT testing a few months following treatment to identify repeat infection; and (6) in pregnant women at a minimum of 3 weeks following treatment to identify persisting or repeat infection so that repeat treatment can be provided promptly to reduce risk for maternal and neonatal morbidity.Following release of the 2010 CDC STD Treatment Guidelines [2], unanswered questions and topics requiring further study on the epidemiology, diagnosis, and management of uncomplicated CT infection remained. In preparation for the 2015 CDC STD Treatment Guidelines, the CDC convened an advisory group in...

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“…Pharyngeal testing for N. gonorrhoeae should be performed in MSM who have received oral intercourse during that interval. Although pharyngeal C. trachomatis screening is not a recommendation, studies have described a propensity of pharyngeal C. trachomatis carriage to result in disease transmission to genital sites (17,18). More-frequent screening may be indicated per additional sexual risk factors.…”

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confidence: 99%

Expansion of Comprehensive Screening of Male Sexually Transmitted Infection Clinic Attendees with Mycoplasma genitalium and Trichomonas vaginalis Molecular Assessment: a Retrospective Analysis

Munson

Wenten²,

Jhansale³

et al. 2017

J Clin Microbiol

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Of 1,493 encounters of males at a sexually transmitted infection (STI) clinic in a community with a high prevalence of STI, Chlamydia trachomatis was detected in 8.7% and Neisseria gonorrhoeae was detected in 6.6%. Additional Trichomonas vaginalis and Mycoplasma genitalium screening found 17.4% and 23.9% of the encounters, respectively, to be positive for STI. STI agents were detected in 13.7% of urine specimens; addition of pharyngeal and rectal collections to the analysis resulted in detection of STI agents in 19.0% and 23.9% of encounters, respectively. A total of 101 (23.8%) encounters of identified STI involved sole detection of M. genitalium. Expansion of the STI analyte panel (including M. genitalium) and additional specimen source sampling within a comprehensive STI screening program increase identification of male STI carriers. KEYWORDS Mycoplasma genitalium, transcription-mediated amplification,Trichomonas vaginalis E xtraurogenital screening for agents of sexually transmitted infection (STI) has been advocated in a number of clinical and public health scenarios (1). Studies have reported increased rates of Chlamydia trachomatis and Neisseria gonorrhoeae detection from pharyngeal and rectal specimens via nucleic acid amplification testing compared to rates found with culture (2-7). Moreover, differences in clinical and in vitro detection rates yielded by transcription-mediated amplification (TMA) versus DNA amplification modalities have been demonstrated (4-9), likely owing to target capture-based removal of endogenous inhibitors (10, 11). Detection of Trichomonas vaginalis RNA from pharyngeal specimens (12) and Mycoplasma genitalium RNA from urine specimens (13) of male STI clinic attendees has recently been reported on the basis of commercial TMA assays. The purpose of this investigation was to assess both the capacity of TMA for detection of M. genitalium from pharyngeal and rectal specimens and the potential for multispecimen analysis in the overall identification of male carriers of STI agents.(Results of this work were presented in part at ASM Microbe, Boston, MA, 16 to 20 June 2016.)With an Institutional Review Board-approved protocol, screening practices for male attendees of a Milwaukee, WI, STI clinic were audited from March 2014 through December 2015. The high-STI-prevalence nature of this community was noted previously (14). Aliquots of first-void urine were dispensed into Aptima urine specimen transport tubes (Hologic, San Diego, CA). Pharyngeal and rectal swab specimens were obtained using the Aptima unisex swab specimen collection kit (Hologic).

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Chlamydia trachomatisandNeisseria gonorrhoeaeTransmission from the Oropharynx to the Urethra among Men Who Have Sex with Men

Abstract: A more complete understanding of the risks of transmission of C. trachomatis and N. gonorrhoeae from oropharynx to urethra will help inform prevention and screening programs.

Cited by 104 publications

References 11 publications

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

Diagnosis and Management of UncomplicatedChlamydia trachomatisInfections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

Expansion of Comprehensive Screening of Male Sexually Transmitted Infection Clinic Attendees with Mycoplasma genitalium and Trichomonas vaginalis Molecular Assessment: a Retrospective Analysis

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