Extragenital Gonorrhea and Chlamydia Testing and Infection Among Men Who Have Sex with Men—STD Surveillance Network, United States, 2010–2012

BACKGROUND:  Gonorrhea (GC) and chlamydia (CT) are the most common notifiable diseases reported to CDC. GC and CT, and the behaviors associated with acquiring them, may increase the likelihood of acquiring and transmitting HIV. Because extragenital (pharyngeal or rectal) GC/CT is often asymptomatic, CDC recommends annual screening for rectal GC/CT and pharyngeal GC for men who have sex with men (MSM) who have had rectal and pharyngeal sex. We sought to describe extragenital GC/CT testing and infections among MSM attending sexually transmitted disease (STD) clinics.

METHODS:  The STD Surveillance Network (SSuN) collects standardized patient data from 42 STD clinics within 12 jurisdictions. We examined records of MSM attending these clinics during July 2011–June 2012 and assessed the proportions 1) tested and 2) positive for extragenital GC/CT at their most recent visit or in the preceding 12 months.

RESULTS:  Of 21,994 MSM who had one or more visits, 18,460 (83.9%, range 55.9%–96.4% by jurisdiction) were tested for urogenital GC, 14,484 (65.9%, range 0%–80.7%) for pharyngeal GC, 11,092 (50.4%, range 0%–65.2%) for rectal GC, 17,898 (81.4%, range 23.8%–96.4%) for urogenital CT, 6,961 (31.7%, range 0%–79.9%) for pharyngeal CT, and 10,091 (45.9%, range 0%–64.8%) for rectal CT. Of MSM ever tested, 2,056 (11.1%) tested positive at least once for urogenital GC, 1,144 (7.9%) for pharyngeal GC, 1,136 (10.2%) for rectal GC, 1,495 (8.4%) for urogenital CT, 199 (2.9%) for pharyngeal CT, and 1,427 (14.1%) for rectal CT. Extragenital infections comprised 52.5% of all GC/CT infections among our sample. GC and CT co-infections at any anatomic site were seen in 799 visits, accounting for 20.4% of the 3,910 visits where MSM tested positive for GC and 25.6% of the 3,124 visits where MSM tested positive for CT. Overall, 72.8% of men with positive extragenital GC tests and 90.3% of men with positive extragenital CT tests had negative urethral tests performed at the same visit and would not have been identified or treated if only urethral screening were performed.

CONCLUSIONS:  Extragenital GC and CT infections were common among MSM tested at STD clinics, but many MSM were not tested. In our sample, a substantial number of extragenital GC/CT infections did not have concurrent urethral infections and would not have been detected or treated if only urethral screening were performed. Extragenital testing can detect additional infections and may help identify MSM at high risk of acquiring or transmitting HIV.