Background Saint Louis, Missouri (USA) consistently reports high per capita rates of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (Ct). Asymptomatic testing for these STIs has traditionally involved genital testing alone. U.S. screening guidelines recommend GC/Ct testing at all sites of sexual exposure in men who have sex with men (MSM) and other high-risk groups. We instituted a policy to promote extragenital screening, in addition to genitourinary screening, for higher risk patients in a public health STI clinic. The purpose of this study is to assess implementation of this programme as well as the prevalence of STI at each site in our population.
Methods We conducted a retrospective study to compare rates of GC and Ct under enhanced testing conditions (genital plus rectal/pharyngeal if exposed) from October 2012–January 2013. As part of the routine intake interview, patients presenting for testing were asked about sexual history and behavioural information.
Results Of 441 patients seen during the study period, 68.9% (N = 304) were tested at an extragenital site. Among persons undergoing extragenital testing, 99.7% (N = 303) had an oropharyngeal test, and 7.2% (N = 22) had a rectal test performed. Extragenital testing showed that 4.6% of patients (N = 14) had oropharyngeal GC, 1.0% (N = 3) had oropharyngeal Ct. Of the patients that underwent rectal testing, 9.1% (N = 2) had GC and 4.5% (N = 1) had Ct. Oral GC was found in 20.0% of patients with genital gonorrhoea (N = 15). In addition, 12.0% of the positive tests were in patients that had negative genital site testing.
Conclusion Implementation of an enhanced GC/Ct testing policy identified significant numbers of patients with isolated oropharyngeal and rectal infection. The incidence of men with concurrent genital and oropharyngeal GC as well as the predominance of men accounting for the discordant oropharyngeal GC infection, may indicate the need for increased oropharyngeal testing in the general population.
- Rectal testing
- STI clinic
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