Spontaneous clearance of urogenital, anorectal and oropharyngealChlamydia trachomatisandNeisseria gonorrhoeaein women, MSM and heterosexual men visiting the STI clinic: a prospective cohort study

Abstract

ObjectiveChlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections can clear without treatment. Despite high prevalence of anorectal infections in men who have sex with men (MSM) and women, studies on anorectal clearance are scarce. Moreover it is unknown whether bacterial load affects urogenital/anorectal CT clearance. In this prospective cohort study, CT and NG clearance is assessed at three anatomical sites of men and women.MethodsCT-positive and NG-positive MSM, heterosexual men and women ≥18 years of age visiting our STI clinic between 2011 and 2013 underwent a repeat test when returning for treatment (n=482). The primary outcome was clearance, defined as a positive nucleic acid amplification test (NAAT) at screening-consultation, followed by a negative NAAT at treatment-consultation. Sociodemographics, sexual risk behaviour and CT bacterial load (inhouse quantitative PCR) were tested as determinants for clearance using multivariable logistic regression for CT and Fisher’s exact test for NG.ResultsCT clearance was 9.1% (10/110) for urine, 6.8% (20/292) for vaginal swabs, 12.7% (8/63) for anorectal swabs (ie, 4.0% [1/25] in MSM and 18.4% [7/38] in women) and 57.1% (4/7) for oropharyngeal swabs. For NG this was 33.3% (2/6), 28.6% (2/7), 20.0% (2/10) and 27.3% (6/22), respectively. The number of days between tests (median 10, IQR 7–14) was not associated with clearance. Lower bacterial load at screening was the only predictor for CT clearance (urine mean 1.2 vs 2.6 log CT/mL, p=0.001; vaginal swabs mean 2.1 vs 5.2 log CT/mL p<0.0001; anorectal swabs mean 2.0 vs 3.7 log CT/mL, p=0.002). None of the tested determinants were associated with NG clearance.ConclusionsThis study reports the largest number of anorectal infections tested for CT and NG clearance to date. Clearance in all sample types was substantial: between 7% and 57% for CT, and between 20% and 33% for NG (notwithstanding low absolute numbers). CT clearance was associated with a lower load at screening. However, not all individuals with low bacterial CT load cleared the infection, hampering STI guideline change.

STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany

“…Asymptomatic STI are common in pharyngeal and rectal infections. Oro-penile and oro-anal sex as well as the use of saliva are relevant for the transmission of STI, particularly for gonorrhoeae [66,67]. Spontaneous clearance of CT and NG has been reported [67] but sexual abstinence for a not defined time is not an option for most clients.…”

“…Oro-penile and oro-anal sex as well as the use of saliva are relevant for the transmission of STI, particularly for gonorrhoeae [66,67]. Spontaneous clearance of CT and NG has been reported [67] but sexual abstinence for a not defined time is not an option for most clients. Even though they can be self-limiting, ECDC and WHO recommend treatment of all asymptomatic pharyngeal NG infections due to their high potential of generating AMR in this localisation through genetic exchange with commensal pathogens.…”

Mycoplasma genitalium: A Review

“…In contrast, spontaneous clearance is also seen as with other STIs, e.g. chlamydia and gonorrhoea [33–37]. In a cohort study of Ugandan female sex workers, 55 % of women spontaneously cleared infection within 3 months, 83 % in 6 months and 93 % in 12 months.…”

Spontaneous clearance ofChlamydia trachomatisaccounting for bacterial viability in vaginally or rectally infected women (FemCure)

“…CT disproportionally affects women in terms of its occurrence and burden of sequelae, including pelvic inflammatory disease, ectopic pregnancy, tubal infertility and chronic abdominal pain 3–5. However, spontaneous clearance of urogenital CT has been reported,6 between 19%–54% within 1 year7 8 and 6%–44% between diagnosis and treatment,9–13 using quantitative PCR tests (or nucleic acid amplification tests (NAATs)). Studies on rectal clearance are scarce, reporting 18.2% in men and women (2/11; median interval 11 days)14 and 4.0% (1/25) in men and 18.4% (7/38) in women (median interval 8 days) 13.…”

“…However, spontaneous clearance of urogenital CT has been reported,6 between 19%–54% within 1 year7 8 and 6%–44% between diagnosis and treatment,9–13 using quantitative PCR tests (or nucleic acid amplification tests (NAATs)). Studies on rectal clearance are scarce, reporting 18.2% in men and women (2/11; median interval 11 days)14 and 4.0% (1/25) in men and 18.4% (7/38) in women (median interval 8 days) 13. Research demonstrated lower CT bacterial load as the only determinant for clearance 13…”