Extragenital Gonorrhoea in Men Who Have Sex with Men: A Retrospective Study in a STI Clinic in Lisbon, Portugal.

Abstract

Recent studies worldwide reveal a significant prevalence of extragenital infections by Neisseria gonorrhoeae amongmen who have sex with men. We aimed to analyse the frequency and characteristics of extragenital gonococcal infections diagnosedin men who have sex with men in a walk-in Sexually Transmitted Infection clinic in Lisbon, Portugal. We conducted a cross-sectional, retrospective study of the anorectal and/or oropharyngeal Neisseriagonorrhoeae infections in men who have sex with men, diagnosed in our Sexually Transmitted Infection clinic between January 2014and December 2016. We found extragenital infection in 87 cases of gonorrhoea identified in men who have sex with men in this period, including:49 cases of anorectal disease, 9 of oropharyngeal disease, 13 cases of infection at both extragenital sites, and 16 of simultaneousextragenital and urogenital gonorrhoea. Patients' ages ranged from 17 to 64 years (median: 28 years). Forty-seven (54%) of thepatients did not present with any extragenital symptoms. Thirty (35%) were human immunodeficiency virus-1-positive. Since most extragenital Neisseria gonorrhoeae infections are asymptomatic, they may be missed and go untreated unlessactively investigated. Current international guidelines recommend the screening of gonorrhoea at extragenital sites in men who havesex with men because anorectal and oropharyngeal infections constitute a potential disease reservoir, and may facilitate transmissionand/or acquisition of human immunodeficiency virus infection. Our results highlight the relevance of testing men who have sex with men for Neisseria gonorrhoeae at extragenitalsites, regardless of the existence of local complaints. The implementation of adequate screening programmes in Portugal should beconsidered. We also reinforce the need to raise awareness in the population regarding the adoption of prophylactic measures againsttransmission of sexually transmitted infections during anal and/or oral sexual exposure.