4 - The prevalence of positive anorectal gonorrhea and Chlamydia NAAT testing on routine screening for all high resolution anoscopy performed at a community health center

Abstract

Background Our community-based clinic decided to implement routine screening for anorectal Gonorrhea (GC) and Chlamydia (CT) for patients undergoing HRA for anal cancer prevention, due to high risk for asymptomatic GC and CT among our patient population (predominantly HIV+ MSM in NYC) and the impact undiagnosed GC/CT infection may have on recovery after biopsy or ablation of HPV-related lesions. In 2016, the CDC reported a prevalence of anorectal GC and CT of 0.146% and 0.497% in the general population nationally, and 12.1% and 12.7% in MSM in NYC clinics in the STD Surveillance Network. Methods Retrospective chart review for all HRA completed in 2017 using associated CPT and testing codes. Results 839 HRA procedures were done in 2017. Of the anorectal NAATs performed, 6.6% were positive for either GC and/or CT (4% for GC and 3% for CT). Conclusions Implementing routine screening for anorectal GC/CT at every HRA for HPV-related disease revealed a prevalence of concurrent anorectal GC and/or CT infection well above national prevalence for the general population, though at a lower rate than anorectal GC/CT among MSM seeking screening or treatment in NYC DOH clinics. We were unable to make conclusions about how treating these incidental infections impacted recovery after the procedure, as this was outside the scope of this limited chart review. But the prevalence of GC/CT infection discovered in this analysis supports the importance of adding routine GC/CT screening for all patients undergoing HRA for the diagnosis or treatment of HPV-related anal neoplasia.