Neisseria gonorrhea and Chlamydia trachomatis Screening and Diagnosis Among Men Who Have Sex with Men

Background:
Men who have sex with men (MSM) are at increased risk for multiple sexually transmitted diseases (STDs). Numerous reports document a resurgence in unsafe sexual practices among MSM that appears to be associated with increased rates of STDs. Whitman-Walker Clinic (WWC) is a non-profit community-based health organization serving the Washington, D.C. metropolitan region established by and for the gay and lesbian community.

Objective:
To evaluate Neisseria gonorrhea and Chlamydia trachomatis screening and diagnosis at the Gay Men's Health & Wellness Clinic (GMH&WC), a Tuesday and Thursday evening STD clinic for men.

Method:
Urethral specimens were collected from symptomatic clients, urine specimens were collected from asymptomatic men and anyone refusing a urethral swab, and pharynx and rectal specimens were collected based on symptoms and sexual history. Testing was done using the Becton-Dickinson SDA Probe-Tec assay.

Result:
A total of 2,941 MSM visited the GMH&WC from August 2006 – August 2007. Of the 426 urethral specimens collected, 109 (25.6%) were positive for gonorrhea, 45 (10.6%) were positive for chlamydia, and 10 (2.3%) were positive for both. Of the 2,088 urine specimens collected, 12 (0.6%) were positive for gonorrhea, 79 (3.8%) were positive for chlamydia, and 3 (0.1%) were positive for both. Of the 577 pharyngeal specimens collected, 58 (10.1%) were positive for gonorrhea, 5 (0.9%) were positive for chlamydia, and 3 (0.5%) were positive for both. Of the 204 rectal specimens collected, 16 (7.8%) were positive for gonorrhea, 24 (11.8%) were positive for chlamydia, and 9 (4.4%) were positive for both.

Conclusion:
Gonorrhea screening of asymptomatic MSM using urine specimens yielded few positive results. Chlamydia screening/diagnosis of the pharynx also yielded few positive results. More chlamydia than gonorrhea was detected in the rectum through routine screening/diagnosis.

Implications:
Due to diminishing public health resources, targeted STD screening among MSM should be data driven.