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Inadequate performance of a risk score to predict asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infection among cisgender men who have sex with men
  1. Emily Rowlinson1,
  2. James P. Hughes2,
  3. Christine M. Khosropour1,
  4. Lisa E. Manhart1,3,
  5. Matthew R. Golden4,
  6. Lindley A. Barbee4,5
  1. 1Department of Epidemiology, University of Washington, Seattle, Washington, USA
  2. 2Biostatistics, University of Washington, Seattle, Washington, USA
  3. 3Global Health, University of Washington, Seattle, Washington, USA
  4. 4Medicine, University of Washington, Seattle, Washington, USA
  5. 5HIV/STD, Public Health - Seattle & King County, Seattle, Washington, USA
  1. Correspondence to Dr Emily Rowlinson, Epidemiology, University of Washington Department of Epidemiology, Seattle, WA 98195, USA; erowlin{at}uw.edu

Abstract

Objectives Epidemiological treatment of persons who are sexual contacts to partners with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) often results in treatment of uninfected persons, which may increase the risk of antibiotic-resistant infections. We sought to identify the predictors of NG and/or CT infections to develop a risk score that could be used to limit epidemiological treatment to persons most likely to have these infections.

Methods We included visits to the Public Health - Seattle & King County Sexual Health Clinic by asymptomatic cisgender men who have sex with men (MSM) aged ≥18 who presented as a sexual contact to partner(s) with CT or NG infection between 2011 and 2019. We used logistic regression to estimate the odds of CT and/or NG infections associated with demographic and clinical predictors, selecting the final set of predictors using the Akaike information criteria and obtaining score weights from model coefficients. We used a cross-validation approach to obtain average model discrimination from each of 10 models, leaving out 10% of the data, and evaluated sensitivity and specificity at various score cut-offs.

Results The final model for predicting NG or CT infection included seven predictors (age <35 years, HIV status, receptive oral sex in the prior 2 months, CT diagnosis, condomless receptive anal intercourse, condomless insertive anal intercourse and methamphetamine use in the prior 12 months). Model discrimination, as measured by the receiver operating curve, was 0.60 (95% CI 0.54 to 0.66). Sensitivity for detection of infection was ≥90% for scores ≥3, ≥5 and ≥7; specificity for these cut-offs was <16%. At scores ≥9, ≥12 and ≥14, specificity increased but sensitivity decreased to ≤76%.

Conclusions Our risk score did not sufficiently discriminate between asymptomatic MSM with and without NG/CT infection. Additional studies evaluating epidemiological treatment as a standard of care in diverse populations are needed to guide best practices in the management of contacts to NG/CT infection.

  • neisseria gonorrhoeae
  • chlamydia infections
  • epidemiology

Data availability statement

No data are available. The data used for this analysis include potentially identifying information, including race and age, that when used along with date of NG diagnosis could potentially be used to identify individuals. These data also contain information on sexual risk behaviour and HIV status that could potentially cause harm to individuals who are identified. As such, we are unable to provide the data as a supplemental file.

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Data availability statement

No data are available. The data used for this analysis include potentially identifying information, including race and age, that when used along with date of NG diagnosis could potentially be used to identify individuals. These data also contain information on sexual risk behaviour and HIV status that could potentially cause harm to individuals who are identified. As such, we are unable to provide the data as a supplemental file.

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Footnotes

  • Handling editor Miłosz Parczewski

  • Contributors ER codeveloped the analysis plan, conducted the data cleaning/analysis and wrote the manuscript. JPH codeveloped the analysis plan, contributed substantially to data analysis and interpretation of results, and contributed to manuscript development. CMK provided input on study design and contributed substantially to interpretation and presentation of the results and development of the manuscript. LM contributed to interpretation of the results and development of the manuscript. MRG provided input on study design and contributed to interpretation of the results and development of the manuscript. LAB conceptualised the study, including the study design, codeveloped the analysis plan and contributed substantially to the interpretation of results and development of the manuscript. ER serves as the guarantor for this work.

  • Funding This work was supported by the National Institutes of Health (grant numbers 1R03AI156261-01 to LAB and TR002318 to ER).

  • Competing interests CMK: donations of specimen collection kits and reagents from Hologic for research outside the submitted work. LM: Hologic and Nabriva for research support unrelated to this work. MRG: Hologic for research support unrelated to this work. LAB: Hologic, Nabriva and SpeeDx for research support unrelated to this work.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.