Triple site sexually transmitted infection testing as a crucial component of surveillance for men who have sex with men: A prospective cohort study

Abstract

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are common among men who have sex with men (MSM). Many oropharyngeal and anorectal infections remain asymptomatic. We aimed to evaluate triple-site screening following PrEP introduction. We enrolled a prospective cohort study including 210 asymptomatic MSM during 2019–2020, analyzed by groups: HIV positive (HIV+), HIV−uninfected using PrEP (HIV−/PrEP+), or HIV-uninfected not using PrEP (HIV−/PrEP−). A self-administered questionnaire captured demographic information and sexual risk-taking behaviors. CT/NG testing results were compared between study groups and predictors of infection were evaluated. We included 59 HIV+, 70 HIV−/PrEP+, and 81 HIV−/PrEP− subjects. 30% ( n = 62) of participants tested positive for CT/NG. HIV−/PrEP+ group had highest proportion of infections ( n = 33, 47%) followed by HIV−/PrEP− ( n = 16, 22%) and HIV+ ( n=13, 20%; p < .001). Importantly, 98% (80/82) of pharyngeal/anorectal CT/NG infections were missed in genitourinary tract screening alone. PrEP use and previous syphilis infection were the strongest risk factor for CT/NG. Extra-genital asymptomatic CT/NG infections were prevalent among MSM. These data highlight the importance of routine extra-genital CT/NG testing in asymptomatic sexually active MSM. The study describes the consequences for three-site testing lack of implementation in the PrEP era.

Sexually transmitted coinfections among at-risk HIV-positive MSM: implications for optimal preemptive treatment

“…The other rationale of the recommendation has also been attributed to the concerns about cost and turnaround time of microbiologic diagnostics. In addition, asymptomatic extragenital infections are prevalent among MSM; thus, diagnoses will be missed if pharyngeal and anorectal screenings are not performed (28)(29)(30)(31). Although sampling from multiple anatomical sites could yield a higher detection rate, the testing cost incurred also increases (32).…”

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

“…STI screening and treatment should be addressed in relation to sexual practices rather than specific populations 451 to ensure inclusive and personalized recommendations 375 . Importantly, STIs affecting the anorectum might be asymptomatic 210 , and there might be a risk of transmitting protozoal infections (for example, Giardia intestinalis) and enteropathogenic bacterial infections (for example, Escherichia coli) during RAI through oral-anal stimulation and indirect contamination of objects used during intercourse or fingers 222 . HPV, human papillomavirus; IBD, inflammatory bowel disease; PEP, post-exposure prophylaxis; PrEP, pre-exposure prophylaxis.…”

“…If bacterial STIs are untreated, they can cause infectious proctitis 207,208 , which might be a risk factor for painful RAI, including anodyspareunia 209 . As STIs of the anorectum (and throat) are more likely to be asymptomatic than those of the genitalia 210 , it is particularly important to screen patients engaging in RAI for the appropriate STIs. Best practices for STI screening include urinary, oropharyngeal and anorectal swabs (Fig.…”

Risk of sexually transmitted infections among U.S. military service members in the setting of HIV pre-exposure prophylaxis use

“…Of particular importance is the role of extragenital infection in MSM, which can account for >50% of chlamydia or gonorrhea infections and is often asymptomatic [ 14 ]. Furthermore, a recent prospective study of three site screening by Zucker and colleagues found that MSM on PrEP had the highest rates of extragenital gonorrhea or chlamydia with a prevalence of 47% compared with HIV-infected (20%) and MSM not HIV-infected and on PrEP (22%) [ 15 ]. Importantly, 98% of the infectious would have been missed with urogenital screening alone.…”