Routine universal testing versus selective or incidental testing for oropharyngeal Chlamydia trachomatis in women in the Netherlands: a retrospective cohort study

Evers, Ymke J.; Liere, Geneviève A F S van; Dukers-Muijrers, Nicole H T M; Bergen, Jan van; Kuizenga-Wessel, Sophie; Hoebe, Christian J. P. A.

doi:10.1016/s1473-3099(21)00465-5

Cited by 2 publications

(5 citation statements)

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“…Impact of missed CT estimates on STI clinical populations, in women and MSM To understand what these distributions mean in terms of actual CT infections missed, we need to consider CT test positivity in the source population. To give a simple calculation as an illustration, given a pharyngeal CT test positivity of 1–3%, of which 20–40% is single-site pharyngeal CT [ 96 , 98 ] translates to only 0.2–1.2% of women and MSM in clinical care practice who have a single-site pharyngeal CT. Given a rectal CT test positivity of 9%, of which 20% (in women) or 80% (in MSM) is single-site rectal CT, translates to only 1-2% of women who have a single-site rectal CT.…”

Section: Resultsmentioning

confidence: 99%

“…These have been used to reduce missed infections without having to test all people at all anatomic sites. However, selective testing still misses approximately 50–75% of all rectal and pharyngeal CT in both women and MSM [ 96 , 98 , 107 ]. There have been attempts to optimise selective testing criteria on ‘who-to-test’.…”

Section: Resultsmentioning

confidence: 99%

“…There have been attempts to optimise selective testing criteria on ‘who-to-test’. In a large-scale Dutch study based on STI clinical data in routinely tested MSM (1% pharyngeal CT; 2041/176,895) and women (2% pharyngeal CT; 1081/45,774), varying the criteria for testing failed to optimise the performance of selective pharyngeal testing strategies [ 95 , 98 ]. Likewise, attempts to explore algorithms for selective rectal CT testing based on a priori patient characteristics were unsuccessful, yielding low discriminatory power [ 87 ].…”

Section: Resultsmentioning

confidence: 99%

“…Positivity, clearance, load, and viability of pharyngeal CT in women and MSM Pharyngeal CT test positivity is between 1 and 3% in women and in MSM in clinical and non-clinical venues [89,[95][96][97][98][99]. Pharyngeal CT is not associated with reported oral sex.…”

Section: Ct Can Occur At the Pharyngeal And Rectal Sites In Women And...mentioning

confidence: 99%

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Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

et al. 2022

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Background Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection (STI) worldwide. CT is mainly asymptomatic. Test-and-treat strategies are widely implemented to prevent transmission and complications. Strategies are not without controversy in asymptomatic women and men who have sex with men (MSM). Concerns are emerging to test and treat asymptomatic persons for urogenital CT (‘Controversy 1’) and pharyngeal or rectal CT (‘Controversy 2’), whereby testing symptomatic persons is not under debate. Opposed views in CT treatment involve using azithromycin versus doxycycline (‘Controversy 3’). The objective of this review is to provide coverage of these public health and clinical controversies by reviewing the current scientific evidence. Methods A literature search was performed using PubMed for relevant publications between 2018 and September 2021, and iterative retrieval of additional relevant publications. Results Controversy 1. In women, the majority of asymptomatic CT are at the urogenital site, and detections mostly include viable CT. CT easily transmits to a partner and potentially also between the vaginal and rectal areas; the clinical impact of urogenital CT is established, although risks for adverse outcomes are uncertain. Wide-scale testing in asymptomatic women has not resulted in reduced prevalence. In MSM, evidence for the clinical impact of asymptomatic urogenital CT is lacking. Controversy 2. Rectal CT is common in women diagnosed with urogenital CT, but the clinical impact of asymptomatic rectal CT is uncertain. In MSM, rectal CT is common, and most CT infections are at the rectal site, yet the risk of longer term complications is unknown. In both sexes, pharyngeal CT is uncommon and has no documented clinical impact. Controversy 3. In the treatment of rectal CT, doxycycline has superior effectiveness to azithromycin. Evidence has also accumulated on the harms of test-and-treat strategies. Conclusions Current practices vary widely, from widescale test-and-treat approaches to more individual patient- and partner-level case management. Choosing which asymptomatic people to test at what anatomic site, and whether to test or not, requires an urgent (re-)definition of the goals of testing and treating asymptomatic persons. Treatment guidelines are shifting toward universal doxycycline use, and clinical practice now faces the challenge of implementation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Ct Can Occur At the Pharyngeal And Rectal Sites In Women And...mentioning

confidence: 99%

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Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

et al. 2022

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“…kissing and oral-genital sex) is often not collected and individuals may not feel comfortable discussing this with healthcare providers outside STI clinics [98]. A few STI clinics have changed their policy to include selective oropharyngeal STI screening in women and heterosexual men [99,100,101 ▪ ,102,103 ▪ ,104]. Studies found that 18–20% of heterosexual men and 35–46% of women who reported sexual contacts with partners with gonorrhoea tested positive for N. gonorrhoeae at the oropharynx [100,101 ▪ ,102].…”

Section: Screening For Oropharyngeal Infectionsmentioning

confidence: 99%

STI pathogens in the oropharynx: update on screening and treatment

Chow,

Fairley,

Kong

2023

Current Opinion in Infectious Diseases

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Purpose of review The rise in antimicrobial resistance in several STI pathogens such as Neisseria gonorrhoeae has become a public health threat as only one first-line treatment remains. Reducing screening interval for gonorrhoea and chlamydia in high-prevalence populations has been proposed to address antimicrobial stewardship, but this remains controversial. This review aimed to revisit the epidemiology of infections at the oropharynx and review the current screening recommendations and treatment guidelines in different populations. Recent findings Emerging evidence suggests that the oropharynx is the primary anatomical site for gonorrhoea transmission but maybe not for chlamydia transmission. Most international guidelines recommend 3-monthly oropharyngeal gonorrhoea and chlamydia screening for high-prevalence populations (e.g. men who have sex with men) but not low-prevalence populations (e.g. heterosexuals) given the clinical and public health benefits of screening in low-prevalence populations are still unclear. Doxycycline remains the first-line treatment for oropharyngeal chlamydia in most guidelines. However, some countries have moved from dual therapy (ceftriaxone and azithromycin) to monotherapy (ceftriaxone) for oropharyngeal gonorrhoea treatment to address antimicrobial stewardship. Summary The transmission of gonorrhoea and chlamydia is still not fully understood. Further work will be required to evaluate the benefits and harms of reducing screening in high-prevalence populations.

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Routine universal testing versus selective or incidental testing for oropharyngeal Chlamydia trachomatis in women in the Netherlands: a retrospective cohort study

Cited by 2 publications

References 27 publications

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

STI pathogens in the oropharynx: update on screening and treatment

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