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Extragenital Gonorrhea and Chlamydia Positivity and the Potential for Missed Extragenital Gonorrhea With Concurrent Urethral Chlamydia Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics-Sexually Transmitted Disease Surveillance Network, 2015-2019.
Sex Transm Dis. 2020 06; 47(6):361-368.ST

Abstract

BACKGROUND

Extragenital gonorrhea (GC) and chlamydia (CT) are usually asymptomatic and only detected through screening. Ceftriaxone plus azithromycin is the recommended GC treatment; monotherapy (azithromycin or doxycycline) is recommended for CT. In urethral CT-positive/urethral GC-negative persons who are not screened extragenitally, CT monotherapy can lead to GC undertreatment and may foster the development of gonococcal antimicrobial resistance. We assessed urethral and extragenital GC and CT positivity among men who have sex with men (MSM) attending sexually transmitted disease clinics.

METHODS

We included visit data for MSM tested for GC and CT at 30 sexually transmitted disease clinics in 10 jurisdictions during January 1, 2015, and June 30, 2019. Using an inverse-variance random effects model to account for heterogeneity between jurisdictions, we calculated weighted test visit positivity estimates and 95% confidence intervals (CI) for GC and CT at urethral and extragenital sites, and extragenital GC among urethral CT-positive/GC-negative test visits.

RESULTS

Of 139,718 GC and CT test visits, we calculated overall positivity (GC, 16.7% [95% CI, 14.4-19.1]; CT, 13.3% [95% CI, 12.7-13.9]); urethral positivity (GC, 7.5% [95% CI, 5.7-9.3]; CT, 5.2% [95% CI, 4.6-5.8]); rectal positivity (GC, 11.8% [95% CI, 10.4-13.2]; CT, 12.6% [95% CI, 11.8-13.4]); and pharyngeal positivity (GC, 9.1% [95% CI, 7.9-10.3]; CT, 1.8% [95% CI, 1.6-2.0]). Of 4566 urethral CT-positive/GC-negative test visits with extragenital testing, extragenital GC positivity was 12.5% (95% CI, 10.9-14.1).

CONCLUSIONS

Extragenital GC and CT were common among MSM. Without extragenital screening of MSM with urethral CT, extragenital GC would have been undetected and undertreated in approximately 13% of these men. Undertreatment could potentially select for antimicrobial resistance. These findings underscore the importance of extragenital screening in MSM.

Authors+Show Affiliations

From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.No affiliation info availableLos Angeles County Department of Public Health, Los Angeles, CA.Florida Department of Health, Tallahassee, FL.Minnesota Department of Health, Minneapolis, MN.Department of Medicine and Epidemiology, University of Washington, Seattle, WA.Massachusetts Department of Health, Boston, MA.Multnomah County Department of Health, Portland, OR.New York City Department of Mental Health and Hygiene, New York City, NY.Philadelphia Department of Public Health, Philadelphia, PA.San Francisco Department of Public Health, San Francisco, CA.From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32413018

Citation

Abara, Winston E., et al. "Extragenital Gonorrhea and Chlamydia Positivity and the Potential for Missed Extragenital Gonorrhea With Concurrent Urethral Chlamydia Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics-Sexually Transmitted Disease Surveillance Network, 2015-2019." Sexually Transmitted Diseases, vol. 47, no. 6, 2020, pp. 361-368.
Abara WE, Llata EL, Schumacher C, et al. Extragenital Gonorrhea and Chlamydia Positivity and the Potential for Missed Extragenital Gonorrhea With Concurrent Urethral Chlamydia Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics-Sexually Transmitted Disease Surveillance Network, 2015-2019. Sex Transm Dis. 2020;47(6):361-368.
Abara, W. E., Llata, E. L., Schumacher, C., Carlos-Henderson, J., Peralta, A. M., Huspeni, D., Kerani, R. P., Elder, H., Toevs, K., Pathela, P., Asbel, L., Nguyen, T. Q., Bernstein, K. T., Torrone, E. A., & Kirkcaldy, R. D. (2020). Extragenital Gonorrhea and Chlamydia Positivity and the Potential for Missed Extragenital Gonorrhea With Concurrent Urethral Chlamydia Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics-Sexually Transmitted Disease Surveillance Network, 2015-2019. Sexually Transmitted Diseases, 47(6), 361-368. https://doi.org/10.1097/OLQ.0000000000001170
Abara WE, et al. Extragenital Gonorrhea and Chlamydia Positivity and the Potential for Missed Extragenital Gonorrhea With Concurrent Urethral Chlamydia Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics-Sexually Transmitted Disease Surveillance Network, 2015-2019. Sex Transm Dis. 2020;47(6):361-368. PubMed PMID: 32413018.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extragenital Gonorrhea and Chlamydia Positivity and the Potential for Missed Extragenital Gonorrhea With Concurrent Urethral Chlamydia Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics-Sexually Transmitted Disease Surveillance Network, 2015-2019. AU - Abara,Winston E, AU - Llata,Eloisa L, AU - Schumacher,Christina, AU - Carlos-Henderson,Juli, AU - Peralta,Angela M, AU - Huspeni,Dawn, AU - Kerani,Roxanne P, AU - Elder,Heather, AU - Toevs,Kim, AU - Pathela,Preeti, AU - Asbel,Lenore, AU - Nguyen,Trang Q, AU - Bernstein,Kyle T, AU - Torrone,Elizabeth A, AU - Kirkcaldy,Robert D, PY - 2020/5/16/entrez PY - 2020/5/16/pubmed PY - 2021/4/23/medline SP - 361 EP - 368 JF - Sexually transmitted diseases JO - Sex Transm Dis VL - 47 IS - 6 N2 - BACKGROUND: Extragenital gonorrhea (GC) and chlamydia (CT) are usually asymptomatic and only detected through screening. Ceftriaxone plus azithromycin is the recommended GC treatment; monotherapy (azithromycin or doxycycline) is recommended for CT. In urethral CT-positive/urethral GC-negative persons who are not screened extragenitally, CT monotherapy can lead to GC undertreatment and may foster the development of gonococcal antimicrobial resistance. We assessed urethral and extragenital GC and CT positivity among men who have sex with men (MSM) attending sexually transmitted disease clinics. METHODS: We included visit data for MSM tested for GC and CT at 30 sexually transmitted disease clinics in 10 jurisdictions during January 1, 2015, and June 30, 2019. Using an inverse-variance random effects model to account for heterogeneity between jurisdictions, we calculated weighted test visit positivity estimates and 95% confidence intervals (CI) for GC and CT at urethral and extragenital sites, and extragenital GC among urethral CT-positive/GC-negative test visits. RESULTS: Of 139,718 GC and CT test visits, we calculated overall positivity (GC, 16.7% [95% CI, 14.4-19.1]; CT, 13.3% [95% CI, 12.7-13.9]); urethral positivity (GC, 7.5% [95% CI, 5.7-9.3]; CT, 5.2% [95% CI, 4.6-5.8]); rectal positivity (GC, 11.8% [95% CI, 10.4-13.2]; CT, 12.6% [95% CI, 11.8-13.4]); and pharyngeal positivity (GC, 9.1% [95% CI, 7.9-10.3]; CT, 1.8% [95% CI, 1.6-2.0]). Of 4566 urethral CT-positive/GC-negative test visits with extragenital testing, extragenital GC positivity was 12.5% (95% CI, 10.9-14.1). CONCLUSIONS: Extragenital GC and CT were common among MSM. Without extragenital screening of MSM with urethral CT, extragenital GC would have been undetected and undertreated in approximately 13% of these men. Undertreatment could potentially select for antimicrobial resistance. These findings underscore the importance of extragenital screening in MSM. SN - 1537-4521 UR - https://www.unboundmedicine.com/medline/citation/32413018/Extragenital_Gonorrhea_and_Chlamydia_Positivity_and_the_Potential_for_Missed_Extragenital_Gonorrhea_With_Concurrent_Urethral_Chlamydia_Among_Men_Who_Have_Sex_With_Men_Attending_Sexually_Transmitted_Disease_Clinics_Sexually_Transmitted_Disease_Surveillance_Network_2015_2019_ L2 - https://doi.org/10.1097/OLQ.0000000000001170 DB - PRIME DP - Unbound Medicine ER -