Extragenital Gonorrhea and Chlamydia in Exposed Women Attending Two Baltimore City Sexually Transmitted Diseases Clinics

Background: Recommendations from the CDC call for pharyngeal screening of Neisseria gonorrhoeae (GC) and rectal screening of GC and Chlamydia trachomatis (CT) in HIV-infected and at-risk men who have sex with men (MSM). There are currently no recommendations to routinely screen women at extragenital sites. Our aim was to define the prevalence of extragenital GC and CT in women accessing care at two public STD clinics in Baltimore, Maryland and compare it to the prevalence of extragenital infections in MSM and men who have sex with women (MSW).

Methods: All patients attending two inner city STD clinics in Baltimore City between June 1, 2011 and May 31, 2013, who reported extragenital exposures and who were receiving standard genital testing were included in this analysis.  Routine testing using nucleic acid amplification tests for extragenital CT began six months into our study so fewer patients were tested.   Prevalence estimates with 95% confidence intervals (CI) are presented.

Results: A total of 10,539 patients were included in this analysis (88% African American, mean age 29 years, 42% women, 7% MSM, 2.5% HIV infected). The prevalence estimates of any extragenital GC and CT were:  2.4% [95%CI: 1.9-2.9] GC and 3.7% [95% CI: 3.1-4.4] CT in women; 2.6% [95%CI: 2.2-3.1] GC and 1.6% [95% CI: 1.3-2.0] CT in MSW; 18.9% [95%CI: 16.0-22.0] GC and 11.8% [95% CI: 9.4-14.5] CT in MSM. Among women, 30.1% [95% CI: 23.3-37.7;] of all cases of GC and 12.8% [95%CI: 9.8-16.2] of all cases of CT would have been missed if extragenital testing were not done.

Conclusions: Although the prevalence of extragenital gonorrhea and chlamydia is highest among MSM, nearly one third of gonorrhea cases in women would be missed with genital-only testing.