Pharyngeal Gonorrhea and Chlamydial Infections in Men who have Sex with Men, a Hidden Threat to the HIV Epidemic
DOI:
https://doi.org/10.12970/2309-0529.2013.01.01.3Keywords:
Chlamydia Trachomatis, Neisseria Gonorrhea, Men who have Sex with Men, Sexually Transmitted Infections, Pharyngeal infections, Screening, HIV.Abstract
Background: Pharyngeal infections with gonorrhea (GC) and chlamydia (CT) can be missed if screened only by routine methods of urethral or urine specimens and may increase the risk of sexually transmitted infections and HIV acquisition and transmission. The prevalence of pharyngeal GC and CT in men who have sex with men (MSM) has been reported as 5.3-9.2% and 1.4-1.9% respectively. The objective of this study is to determine the rates of pharyngeal GC and CT infections in MSM in the Miami Dade Health Department (MDHD) STD clinic. Methods: Routine screening for pharyngeal GC and CT infections in MSM was implemented in the MDHD STD clinic in October 2011 using APTIMA Combo 2 Assay®. Validation studies were performed in the Florida Department of Health Laboratories prior to implementation of the test. Retrospective review of medical records of individuals tested for pharyngeal GC/CT from October 2011 to March 2012 was performed. Results from urine and rectal GC/CT testing done at the same time from the same individuals were also reviewed. Results: A total of 475 pharyngeal swabs were performed. Fifty-two (10.9%) were positive for GC and 13 (2.7%) were positive for CT. Among the individuals with GC pharyngeal infection, 21 (52.5%) had a positive GC rectal test and 14 (28%) a positive urine test. Among the individuals with CT pharyngeal infection, 3 (30%) had a positive CT rectal test and 1 (7.7%) a positive urine test. Conclusions: The prevalence of pharyngeal GC/CT in MSM in the MDHD STD clinic is higher than what has been previously reported in other centers. The discrepancy between pharyngeal, rectal, and urine tests emphasizes the importance of extragenital testing in the MSM population.References
[1] CDC. http://www.cdc.gov/std/gonorrhea/STDFact-gonorrhea. htm. Available from: http://www.cdc.gov/std/gonorrhea/STDF act-gonorrhea.htm.
[2] CDC. http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia. htm.
[3] http://www.cdc.gov/msmhealth/STD.htm.
[4] Rietmeijer CA, McFarlane M. Web 2.0 and beyond: risks for sexually transmitted infections and opportunities for prevention. Curr Opin Infect Dis 2009; 22(1): 67-71. Epub 2009/06/18.
[5] Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recommendations and reports: Morbidity and mortality weekly report Recommendations and reports / Centers for Disease Control 2010; 59(RR-12): 1-110. Epub 2010/12/17.
[6] Koedijk FD, van Bergen JE, Dukers-Muijrers NH, van Leeuwen AP, Hoebe CJ, van der Sande MA. The value of testing multiple anatomic sites for gonorrhoea and chlamydia in sexually transmitted infection centres in the Netherlands, 2006-2010. Int J STD AIDS 2012; 23(9): 626-31. Epub 2012/10/04.
[7] Baker J, Plankey M, Josayma Y, Elion R, Chiliade P, Shahkolahi A, et al. The prevalence of rectal, urethral, and pharyngeal Neisseria gonorrheae and Chlamydia trachomatis among asymptomatic men who have sex with men in a prospective cohort in Washington, D.C. AIDS patient care and STDs 2009; 23(8): 585-8. Epub 2009/07/14.
[8] http://www.cdc.gov/std/stats11/msm.htm.
[9] Incorporated G-PG-PAfGaCG-P. www.gen-probe.com/ products/aptima.aspx.
[10] Weinstock H, Workowski KA. Pharyngeal gonorrhea: an important reservoir of infection? Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2009; 49(12): 1798-800. Epub 2009/11/17.
[11] CDC Grand Rounds: the growing threat of multidrug-resistant gonorrhea. MMWR Morbidity and mortality weekly report. 2013; 62(6): 103-6. Epub 2013/02/15.
[12] Ronn MM, Ward H. The association between lymphogranuloma venereum and HIV among men who have sex with men: systematic review and meta-analysis. BMC Infect Dis 2011; 11: 70. Epub 2011/03/23.
[13] Kent CK, Chaw JK, Wong W, Liska S, Gibson S, Hubbard G, et al. Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2005; 41(1): 67-74. Epub 2005/06/07.
[14] Park J, Marcus JL, Pandori M, Snell A, Philip SS, Bernstein KT. Sentinel surveillance for pharyngeal chlamydia and gonorrhea among men who have sex with men--San Francisco, 2010. Sexually Transmitted Diseases 2012; 39(6): 482-4. Epub 2012/05/18.
[15] Marcus JL, Bernstein KT, Kohn RP, Liska S, Philip SS. Infections missed by urethral-only screening for chlamydia or gonorrhea detection among men who have sex with men. Sexually Transmitted Diseases 2011; 38(10): 922-4. Epub 2011/09/22.
[16] http://www.cdc.gov/std/stats11/minorities.htm.
[17] Battle TJ, Golden MR, Suchland KL, Counts JM, Hughes JP, Stamm WE, et al. Evaluation of laboratory testing methods for Chlamydia trachomatis infection in the era of nucleic acid amplification. J Clin Microbiol 2001; 39(8): 2924-7. Epub 2001/07/28.
[18] Schachter J, Moncada J, Liska S, Shayevich C, Klausner JD. Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men. Sexually Transmitted Diseases 2008; 35(7): 637-42. Epub 2008/06/04.
[19] Clinic-based testing for rectal and pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections by community-based organizations--five cities, United States, 2007. MMWR Morbidity and mortality weekly report. 2009; 58(26): 716-9. Epub 2009/07/11.
