Genital-only Screenings Overlook Gonorrhea and Chlamydia Cases

While routine genital-only screenings are recommended for gay men and people who are HIV-positive, the method widely misses cases of sexually transmitted infections (STIs) like gonorrhea and chlamydia (especially in women), according to a study published in Sexually Transmitted Disease.

“Gonorrhea and chlamydia are treatable infections, but we can only treat the cases we know about,” the paper’s corresponding author, Khalil Ghanem, an assistant professor of medicine at John Hopkins Bayview Medical Center (JHBMC), said in a press release. “If we want to effectively control the spread of these two diseases, we need to ensure that testing guidelines are as rigorous as possible.”

Looking at over 10,389 who attended a STI clinic in Baltimore between June 2011 and May 2013, a majority of the study’s participants were African American (88%), 5218 were heterosexual men (versus 4,402 women and 769 gay men), the mean age was 29, and 2.5% were infected with HIV.

“The prevalence estimates of any extragenital Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) were as follows: 2.4% GC and 3.7% CT in women, 2.6% GC and 1.6% CT in men who have sex with women, and 18.9% GC and 11.8% CT in men who have sex with men (MSM),” the authors reported.

Based on their findings, the team determined 30.3% and 13.8% of women’s GC and CT cases wouldn’t have been identified if genital-only screening was used, respectively. Furthermore, they found young age was the greatest determinant of extragenital infections in women, with Ghanem pointing out that women 18 or younger were four times more likely to have an extragenital infection.

“Although the prevalence of extragenital gonorrhea and chlamydia is highest in MSM, a significant number of GC and CT infections in young women would be missed with genital-only testing,” the investigators concluded. “Cost-effectiveness analyses are needed to help inform national guidelines on extragenital screening in young women.”