Background: A number of studies show that a majority of Chlamydia and gonorrhea infection in men who have sex with men (MSM) would be undiagnosed and untreated if only a urine screening was conducted. CDC guidelines call for screening of these two infections at urethral, rectal and pharyngeal sites for MSM since both increase the chance of acquisition and transmission of HIV. This study shows the need to provide gonorrhea and Chlamydia extragenital screenings for MSM.
Methods: A retrospective analysis of MSM who attended two MSM Wellness Centers in Louisiana from 2011-2012 was conducted. The inclusion criteria were MSM who were screened for urethral, rectal, and pharyngeal Chlamydia and gonorrhea at first visit. To assess the prevalence of infection at each anatomical site, the urethral, rectal and pharyngeal positivity for Chlamydia and gonorrhea was calculated. The proportion of Chlamydia or gonorrhea infections that would have been missed by urine screen only was calculated.
Results: During 2011-2012, 174 clients were screened for gonorrhea and Chlamydia at all three anatomical sites. Chlamydia or gonorrhea was found in at least one anatomical site at first visit for 12.1% of the clients. Most MSM who were diagnosed with gonorrhea or Chlamydia were infected in the rectum or pharynx (90%). The prevalence of infection varied by anatomical site (Chlamydia: rectal, 6.9%; pharyngeal, 1.0%, and urethral, 0%; for gonorrhea: rectal, 1.7%, pharyngeal, 1.7% and urethral, 1.1%). If only urine screenings were performed, 100% of Chlamydia and 75% of gonorrhea infections would have been missed.
Conclusions: This study shows that the majority of gonorrhea and Chlamydia diagnoses among MSM are missed when only a urine screening is performed. The Louisiana Office of Public Health is working with the Louisiana State Laboratory to include extragenital screenings for gonorrhea and Chlamydia as a clinical standard at clinics serving MSM.