The Centers for Disease Control and Prevention recommends
pharyngeal screening of Neisseria gonorrhoeae (GC) and rectal screening of GC
and Chlamydia trachomatis (CT) in HIV-infected and at-risk men who have sex
with men (MSM). There are currently no recommendations to routinely screen
women at extragenital sites. We define the prevalence of extragenital GC and CT
in women attending 2 urban sexually transmitted disease clinics in Baltimore
City and compare it with the prevalence of extragenital infections in MSM and
men who have sex with women.
All patients who reported extragenital exposures in the
preceding 3 months, who presented for care between June 1, 2011, and May 31,
2013, and who were tested for GC and CT using nucleic acid amplification tests
at all sites of exposure were included in the analyses. We used logistic
regression models to identify risk factors for extragenital infections.
A total of 10,389 patients were included in this analysis
(88% African American; mean age, 29 years; 42% women; 7% MSM; 2.5% HIV
infected). The prevalence estimates of any extragenital GC and CT were as
follows: 2.4% GC and 3.7% CT in women, 2.6% GC and 1.6% CT in men who have sex
with women, and 18.9% GC and 11.8% CT in MSM. Among women, 30.3% of GC
infections and 13.8% of CT infections would have been missed with
urogenital-only testing. Unlike MSM, age ≤ 18 years was the strongest predictor
of extragenital infections in women.
Although the prevalence of extragenital gonorrhea and
chlamydia is highest in MSM, a significant number of GC and CT infections in
young women would be missed with genital-only testing. Cost-effectiveness
analyses are needed to help inform national guidelines on extragenital
screening in young women.
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By: Trebach JD1, Chaulk CP, Page KR, Tuddenham S, Ghanem KG.
- 1From the *Johns Hopkins University School of Medicine, Baltimore, MD; and †Baltimore City Health Department, Baltimore, MD.
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