Detection of Rectal Chlamydia and Gonorrhea in the Miami-Dade Health Department (MDHD) Sexually Transmitted Diseases (STD) Clinic

Background:
Lymphogranuloma Venereum (LGV) infection is a variant of Chlamydia Trachomatis (CT) type serovars L1, L2 and L3, an intracellular obligate bacterium and a cause of proctitis in men having sex with men (MSM). LGV has been implicated as a cofactor in the transmission of HIV. A collaborative effort between STD clinic and laboratory colleagues at Florida Public Health Laboratory Jacksonville, Florida and Centers for Disease Control and Prevention (CDC) ventured use of rectal chlamydia testing after it passed verification study using an off-label real-time assay. Positive results are forwarded to CDC for LGV serovars.

Objective:
Evaluate the outcomes of the newly available rectal CT/ Neisseria Gonorrhea (GC) tests and the rates of coinfection with rectal CT/GC infection and other STD's.

Method:
Patients engaging in anal receptive sex were tested for CT and GC at two of the MDHD STD clinics. Retrospective review of medical charts of patients who tested positive was undertaken.

Result:
There were 206 patients tested for rectal CT/GC. Thirty two (15%) had rectal CT and 3.9% rectal GC. Majority were males (29%) and mostly MSM (78%). This mainly affects the minority populations, Hispanic 47%, Black 37% & non Hispanic 16%. Of those with positive rectal GC/CT, only 15% had symptoms and an abnormal physical exam. Additionally, 15% had a concomitant positive urine testing. Coinfection rates with HIV and syphilis are high, 40% and 31% respectively. No positive tests for LGV serovars have been detected to date.

Conclusion:
This is a preliminary finding of a high rate of rectal Chlamydia in asymptomatic patients who engage in receptive anal sex. Rates of co- infection with HIV and syphilis are also high.

Implications:
Further development of rectal CT and LGV serovars testing as a gold standard in all STD clinics.