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High proportions of rectal and pharyngeal chlamydia and gonorrhoea cases among cisgender men are missed using current CDC screening recommendations
  1. Ryan D Assaf1,2,
  2. Nicole J Cunningham1,
  3. Paul C Adamson3,
  4. Jamieson Trevor Jann1,
  5. Robert K Bolan1
  1. 1 Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
  2. 2 Epidemiology, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
  3. 3 Division of Infectious Diseases, David Geffen School of Medicine, Los Angeles, California, USA
  1. Correspondence to Ryan D Assaf, Health Services, Los Angeles LGBT Center, Los Angeles, California, USA; rassaf{at}lalgbtcenter.org

Abstract

Objectives Pharyngeal and rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are often undiagnosed due to their asymptomatic nature. This study aims to determine (1) the prevalence of CT/NG infections by anatomical site among cisgender men; (2) the proportion of missed CT/NG rectal/pharyngeal infections if urogenital testing alone was performed or screening depended on self-reported behaviour alone; and (3) the predictive probability of self-reported behaviours for rectal CT/NG.

Methods This cross-sectional study used electronic health records collected at a sexual health clinic in Los Angeles from 18 November 2018 until 28 February 2020. The included patients were ≥18 years of age cisgender men who received CT/NG testing at least once during the study period. We calculated the proportion of missed pharyngeal/rectal CT/NG infections if only urogenital testing had been done and if testing was based only on self-reported anal sex. Separately, we ran logistic regressions for predictive probability of self-reported anal sex on CT/NG rectal infections.

Results Overall, there were 13 476 unique patients with 26 579 visits. The prevalence of any extragenital CT/NG infection was 37.28%. Over 80% rectal/pharyngeal CT cases and over 65% rectal/pharyngeal NG cases would be missed if urogenital testing alone was performed. Likewise, over 35% rectal CT/NG cases would be missed had testing relied on self-reported sexual behaviours alone.

Conclusions The proportion of missed rectal and pharyngeal CT/NG infections is high. Our data from a sexual health clinic lend support to three-site opt-out testing for cisgender men attending a sexual health/Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ+) specialty clinic regardless of their sexual orientation or reported sexual behaviours.

  • Chlamydia trachomatis
  • epidemiology
  • men
  • Neisseria gonorrhoeae
  • sexual health

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Handling editor Erica L Plummer

  • Contributors RDA: conception, design, analysis and interpretation of data, drafting, critically revising the manuscript, final approval, and is responsible for the overall content as the guarantor. NJC: conception, design, interpretation of data, drafting, critically revising the manuscript. PCA: interpretation of data, critically revising the manuscript. JTJ, RKB: critically revising the manuscript.

  • Funding PCA’s work was supported by the National Institutes of Health (T32MH080634).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.