Louisiana ranks at or near the top in the nation for GC and CT case rates with 25–28% of cases identified at parish health units (PHU). Louisiana’s Targeted Evaluation Plan was developed to evaluate extra-genital (rectal and pharyngeal) positivity rates at PHUs.
The Louisiana Office of Public Health STD/HIV Program, Laboratory, Bureau of Family Health, and Denver Prevention Training Center (DPTC) collaborated to implement an extra-genital testing pilot at four PHUs in three regions with high GC/CT morbidity. Steps taken to accomplish this included: laboratory validation of anal and pharyngeal GC/CT NAAT testing; extra-genital testing protocol development; multi-language instruction sheets for nurses and patients; and training on the importance of extra-genital testing, specimen collection and project implementation by the SHP STD Medical Director and Nurse Consultant with DPTC assistance. Testing began in February 2016.
Results: In first six weeks of the pilot, 220 patients (241 samples) had extra-genital testing. The prevalence of rectal GC was 21% (7 of 34), pharyngeal 8% (17 of 207), and urogenital 6% (81 of 1344), while the prevalence of rectal CT was 21% (7 of 34), pharyngeal 1.5% (3 of 207), and urogenital 13% (176 of 1344). Thirty patients had urogenital and rectal testing. Of these, 5 (17%) CT infections and 4 (13%) GC infections would have been missed with urogenital testing alone. One hundred ninety-four patients had urogenital and pharyngeal testing. Of these 12 (6%) CT infections and 9 GC infections would have been missed.
The project was implemented after internal collaboration of the OPH Programs and partnership with DPTC. This is an example of a public health department fulfilling a specific public health need. There is strong preliminary evidence that extra-genital testing will identify a significant number of cases that would have been missed testing urogenital sites alone.