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

Wednesday, March 12, 2008
Continental Ballroom
Akbar M. Shahkolahi, PhD , Whitman Wailker Clinic, Washington, DC
Paige Diamant, BA , Whitman-Walker Clinic, Washington, DC
Asha Norris, BS , LAB, Whitman-Walker Clinic, Washington
Gray Border , Whitman-Walker Clinic, Washington
Celestine Hakiruwizera, MD , Whitman-Walker Clinic, Washington
Ala Baloum , Whitman-Walker Clinic, Washington
B. W. Furness, MD, MPH , WWC volunteer physician, Washington, DC

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.

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.

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.

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.

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.

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