Abstract
BackgroundSexually transmitted infection (STI) screening programmes are implemented in many countries to decrease burden of STI and to improve sexual health. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae has a prominent role in these protocols. Most of the screening programmes concerning men having sex with men (MSM) are based on opportunistic urethral testing. In The Netherlands, a history-based approach is used. The aim of this study is to evaluate the protocol of screening anatomic sites for C. trachomatis and N. gonorrhoeae infection based on sexual history in MSM in routine practice in The Netherlands.MethodsAll MSM visiting the clinic for STI in The Hague are routinely asked about their sexual practice during consulting. As per protocol, tests for urogenital, oropharyngeal and anorectal infection are obtained based on reported site(s) of sexual contact. All consultations are entered into a database as part of the national STI monitoring system. Data of an 18 months period were retrieved from this database and analysed.ResultsA total of 1455 consultations in MSM were registered during the study period. The prevalence of C. trachomatis and N. gonorrhoeae per anatomic site was: urethral infection 4.0% respectively and 2.8%, oropharynx 1.5% and 4.2%, and anorectum 8.2% and 6.0%. The majority of chlamydia cases (72%) involved a single anatomic site, which was especially manifest for anorectal infections (79%), while 42% of gonorrhoea cases were single site. Twenty-six percent of MSM with anorectal chlamydia and 17% with anorectal gonorrhoea reported symptoms of proctitis; none of the oropharyngeal infections were symptomatic. Most cases of anorectal infection (83%) and oropharyngeal infection (100%) would have remained undiagnosed with a symptom-based protocol.ConclusionsThe current strategy of sexual-history based screening of multiple anatomic sites for chlamydia and gonorrhoea in MSM is a useful and valid guideline which is to be preferred over a symptom-based screening protocol.
Highlights
Transmitted infection (STI) screening programmes are implemented in many countries to decrease burden of Sexually transmitted infection (STI) and to improve sexual health
We evaluate the protocol of screening multiple anatomic sites for chlamydia and gonorrhoea in a large cohort of men having sex with men (MSM) at an STI clinic in the Netherlands to assess the usefulness of this screening strategy in routine practice
Prevalence of chlamydia and gonorrhoea per anatomic site Based on sexual history, tests for urethral infection were done in all except 4 consultations (99.7%); 1283 (88%) MSM reported fellatio and had oropharyngeal swabs taken while anorectal swabs were obtained from the MSM who reported passive anorectal intercourse (n = 1141; 78%)
Summary
Transmitted infection (STI) screening programmes are implemented in many countries to decrease burden of STI and to improve sexual health. The aim of this study is to evaluate the protocol of screening anatomic sites for C. trachomatis and N. gonorrhoeae infection based on sexual history in MSM in routine practice in The Netherlands. Many countries have implemented national programmes for screening for sexually transmitted infections (STI) The aims of such programmes are to decrease the general burden of STI, to improve physical and sexual. The core component of screening for Chlamydia trachomatis and Neisseria gonorrhoeae infection in MSM is testing for urogenital infection through urine sample or urethral swab. The present United Kingdom National Screening and Testing Guidelines, Norwegian HIV and STI screening protocols, Australian STI screening protocols, and guidelines from the Center for Disease Control and Prevention include specific recommendations for screening for anorectal and oropharyngeal infection in MSM based on reported site of sexual contact [4,5,6,15,16,17]. Data on the prevalence of oropharyngeal chlamydia in MSM is limited, but in most studies the prevalence is < 2% [7,20,21,22]
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