Patterns of Extragenital Chlamydia and Gonorrhea in Women and Men Who Have Sex With Men Reporting a History of Receptive Anal Intercourse

Abstract

Background Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in men who have sex with men (MSM) is risk-based. Despite high frequencies of oral and receptive anal intercourse (RAI) among women, extragenital screening is not recommended. Methods Women (n=175) and MSM (n=224) primarily recruited from a sexually transmitted infections clinic reporting a lifetime history of RAI completed a structured questionnaire and clinician collected swab samples from the rectum, pharynx, vagina (women) and urine (men). CT and GC were detected using two commercial nucleic acid amplified tests (Aptima Combo 2, Hologic, Inc., Bedford, MA; Xpert CT/NG, Cepheid Innovation, Sunnyvale, CA). Results The median age of the population was 26 years, 62% were Caucasian, and 88% were enrolled from a Sexually Transmitted Diseases clinic. Men were more likely than women to have GC (22.8% vs. 3.4%) and CT (21.9% vs. 12.6%). In men vs. women, GC was detected in 16.5% vs. 2.3% of pharyngeal swabs, 11.6% vs. 2.3% of rectal swabs and 5.4% vs. 2.9% of urine samples or vaginal swabs. CT was detected in 2.2% vs. 1.7% of pharyngeal swabs, 17.4% vs. 11.4% of rectal swabs, and 4.5% vs 10.3% for urogenital sites in men vs. women. Overall 79.6% of CT and 76.5% of GC in men and 18.2% of CT and 16.7% of GC in women were detected only in the pharynx or rectum. Conclusion Reliance on urogenital screening alone misses the majority of GC and CT in men and more than 15% of infections in women reporting RAI.

Chlamydia trachomatis Genital Tract Infections: When Host Immune Response and the Microbiome Collide

“…Horizontal transfer between hosts, via the oral-fecal route has been recorded as well, while shedding infectious chlamydial particles through feces is highly prevalent in livestock and other animal models. Whereas most data in regards to rectal C. trachomatis infections was reported in high risk patients such as men who have sex with men, recent studies report a high prevalence in women as well [135,136]. A study in two Canadian sexual health clinics found that 82.4% (n= 433) of the C. trachomatis positive patients were rectal positive, while 30% of Chlamydia cases were positive solely at the rectal site [136].…”

Use of Nucleic Acid Amplification Testing for Diagnosis of Extragenital Sexually Transmitted Infections

“…As previously reported from this study population, nearly 80% of chlamydial and gonococcal infections in men and 16 to 18% of these infections in women were detected only in the pharynx or rectum (14). Extragenital testing for STIs should be considered, especially for men who have sex with men, in whom most infections occur at extragenital sites.…”

“…Urogenital-only testing would have missed 80% of the C. trachomatis-positive and 77% of the N. gonorrhoeae-positive samples in males. In contrast, 82% of the total chlamydial infections and 83% of the total gonococcal infections in women were detected using the vaginal sample alone (14). …”

“…This is a secondary analysis of a study evaluating the patterns of extragenital chlamydia and gonorrhea in men and women reporting a lifetime history of ever having receptive anal sex (14). Samples were collected from participants 18 to 62 years of age who attended the Sexually Transmitted Diseases Clinic at the Allegheny County Health Department (ACHD) and Magee-Womens Hospital of the University of Pittsburgh Medical Center (UPMC) and who reported a lifetime history of receptive anal intercourse.…”

“…A study evaluating rectal swab samples sent to a commercial testing laboratory from 52,063 U.S. men aged 15 to 60 years found that 8.8% had rectal gonorrhea and 11% had rectal chlamydia (8). Studies have shown that urogenital screening alone misses infections in men and women who are positive in extragenital sites only (9,10,11,12,13,14).…”