Pharyngeal screening for Chlamydia trachomatis, more harm than good?

Abstract

Urogenital Chlamydia trachomatis infections can result in urethritis in men and late sequelae in women, such as pelvic inflammatory disease and infertility. Heterosexual transmission of chlamydia is in most cases via genital contact. Pharyngeal C trachomatis infections are for the vast majority asymptomatic and without complications. However, the clinical relevance of transmission to genital sites via orogenital contact is a matter of ongoing debate. Male-to-female transmission of C trachomatis via oral sex has been described, 1 Marcus CJL Kohn RP Barry PM Philip SS Bernstein KT Chlamydia trachomatis and Neisseria gonorrhoeae transmission from the female oropharynx to the male urethra. Sex Transm Dis. 2011; 38: 372-373 Google Scholar but in general, the pharyngeal C trachomatis bacterial load is lower 2 Wijers JNAP Dukers-Muijrers NHTM van Liere GAFS Dirks JAMC Wolffs PFG Hoebe CJPA Men and women have an equal oropharyngeal and anorectal Chlamydia trachomatis bacterial load: a comparison of 3 anatomic sites. J Infect Dis. 2021; 223: 1582-1589 Google Scholar and pharyngeal C trachomatis viability is diminished in comparison with anorectal and urogenital infections. 3 Dukers-Muijrers NHTM Wolffs P Lucchesi M et al. Oropharyngeal Chlamydia trachomatis in women; spontaneous clearance and cure after treatment (FemCure). Sex Transm Infect. 2021; 97: 147-151 Google Scholar Routine universal testing versus selective or incidental testing for oropharyngeal Chlamydia trachomatis in women in the Netherlands: a retrospective cohort studyNo optimal testing scenario was available for pharyngeal C trachomatis, in which only a selection of high-risk women needs to be tested to find most pharyngeal C trachomatis infections. The relative low prevalence of pharyngeal-only C trachomatis (0·5%) and probably limited clinical and public health effect do not provide support for routine universal testing. Full-Text PDF