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Rectal chlamydia - A reservoir of undiagnosed infection in MSM
  1. Naa Torshie Annan (torshie.annan{at}fph-tr.nhs.uk)
  1. Chelsea & Westminster Hospital NHS Foundation Trust, United Kingdom
    1. Ann Sullivan (ann.sullivan{at}chelwest.nhs.uk)
    1. Chelsea and Westminster Hospital, United Kingdom
      1. Achyuta Nori (achyuta.nori{at}gmail.com)
      1. Chelsea & Westminster Hospital NHS Foundation Trust, United Kingdom
        1. Polia Naydenova (polianaydenova{at}hotmail.com)
        1. Chelsea & Westminster Hospital NHS Foundation Trust, United Kingdom
          1. sarah alexander (sarah.alexander{at}hpa.org.uk)
          1. Health Protection Agency, United Kingdom
            1. Alex McKenna (alex.mckenna{at}chelwest.nhs.uk)
            1. Chelsea & Westminster Hospital NHS Foundation Trust, United Kingdom
              1. B Azadian
              1. GUM/HIV Directorate, Chelsea & Westminster Hospital NHS Foundation Trust, London, United Kingdom
                1. Sundhiya Mandalia (s.mandalia{at}imperial.ac.uk)
                1. Chelsea & Westminster Hospital NHS Foundation Trust, United Kingdom
                  1. Marco Rossi (marco.rossi{at}chelwest.nhs.uk)
                  1. Chelsea & Westminster Hospital NHS Foundation Trust, United Kingdom
                    1. Helen Ward (h.ward{at}imperial.ac.uk)
                    1. Imperial College London
                      1. Nneka Nwokolo (nneka.nwokolo{at}chelwest.nhs.uk)
                      1. Chelsea & Westminster Hospital NHS Foundation Trust, United Kingdom

                        Abstract

                        Objective: To determine the prevalence of rectal chlamydia infection in a cohort of men who have sex with men (MSM) and the proportion of infection that would be missed without routine screening.

                        Methods: MSM presenting to four HIV/GUM outpatient clinics at the Chelsea & Westminster Hospital NHS Foundation Trust between 1/11/05 and 29/9/06 were offered testing for rectal chlamydia infection in addition to their routine screen for sexually transmitted infections (STIs). Chlamydia trachomatis (CT) tests were performed using the Beckton-Dickinson Probe-Tec Strand Displacement Assay (B-D Probetec SDA). Positive samples were re-tested at the Sexually Transmitted Bacteria Reference Laboratory (STBRL), to confirm the result and identify Lymphogranuloma venereum (LGV) associated serovars.

                        Results: A total of 3076 men were screened. We found an 8.2% prevalence of infection with CT (LGV and non-LGV serovars) in the rectum and 5.4% in the urethra. The HIV and rectal chlamydia co-infection rate was 38.1%. The majority of rectal infections {69.2%, (171/247)} were asymptomatic and would have been missed if routine screening had not been undertaken. Of the samples re-tested, 94.2% (227/242) rectal and 91.8%, (79/86) urethral specimens were confirmed CT positive and 36 cases of LGV were identified.

                        Conclusion: Our data shows a high rate of rectal chlamydia infection, the majority of which were asymptomatic. We recommend routine screening for rectal chlamydia in men at risk, as this may represent an important reservoir for the onward transmission of infection.

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