Optimizing Screening for Anorectal, Pharyngeal, and Urogenital Chlamydia trachomatis and Neisseria gonorrhoeae Infections in At-Risk Adolescents and Young Adults in New Orleans, Louisiana and Los Angeles, California, United States.

TitleOptimizing Screening for Anorectal, Pharyngeal, and Urogenital Chlamydia trachomatis and Neisseria gonorrhoeae Infections in At-Risk Adolescents and Young Adults in New Orleans, Louisiana and Los Angeles, California, United States.
Publication TypePublication
Year of Publication2021
AuthorsMan OM, Ramos WE, Vavala G, Goldbeck C, Ocasio MA, Fournier J, Romero-Espinoza A, M Fern√°ndez I, Swendeman D, Lee S-J, Comulada S, Rotheram-Borus MJane, Klausner JD
JournalClin Infect Dis
Volume73
Issue9
Paginatione3201-e3209
Date Published2021 11 02
ISSN1537-6591
KeywordsAdolescent, Chlamydia Infections, Chlamydia trachomatis, Female, Gender Identity, Gonorrhea, Homosexuality, Male, Humans, Infant, Newborn, Los Angeles, Louisiana, Male, Neisseria gonorrhoeae, New Orleans, Pharynx, Prevalence, Sexual and Gender Minorities, United States, Young Adult
Abstract

<p><b>BACKGROUND: </b>Public health organizations have inconsistent recommendations for screening adolescents and young adults for Chlamydia trachomatis and Neisseria gonorrhoeae infections. Guidelines suggest different combinations of anorectal, pharyngeal, and urogenital testing based on age, sex, and sexual activity. Further evaluation of how identity and behaviors impact the anatomic distribution of C. trachomatis and N. gonorrhoeae infection is needed to optimize future screening practices.</p><p><b>METHODS: </b>We assessed the positivity of C. trachomatis and N. gonorrhoeae infections at different anatomic sites in a cohort of at-risk sexually active adolescents and young adults aged 12-24 years in New Orleans, Louisiana and Los Angeles, California. Participants were tested for C. trachomatis and N. gonorrhoeae at 3 sites (anorectum, pharynx, and urethral/cervix) every 4 months using self-collected swabs. We stratified anatomic distributions of infection into 4 gender and sexual behavior categories: (1) cisgender men who have sex with men and transgender women (MSMTW); (2) cisgender heterosexual males; (3) cisgender heterosexual females; and (4) gender minorities assigned female at birth.</p><p><b>RESULTS: </b>While three-site testing detected all infections, two-site (anorectum and urethra/cervix) testing identified 92%-100% of C. trachomatis or N. gonorrhoeae infections in participants assigned female at birth and cisgender heterosexual males. For MSMTW, two-site anorectal and pharyngeal testing vs single-site anorectal testing increased the proportion of individuals with either infection from 74% to 93%.</p><p><b>CONCLUSIONS: </b>Sexual behavior and gender identity may influence detection of C. trachomatis and N. gonorrhoeae infections at specific anatomic testing sites. Testing guidelines should incorporate sexual behavior and gender identity.</p><p><b>CLINICAL TRIALS REGISTRATION: </b>NCT03134833.</p>

DOI10.1093/cid/ciaa1838
Alternate JournalClin Infect Dis
PubMed ID33300564
PubMed Central IDPMC8825228
Grant ListP30 AI028697 / AI / NIAID NIH HHS / United States
P30 MH058107 / MH / NIMH NIH HHS / United States
U19 HD089886 / HD / NICHD NIH HHS / United States