Pharyngeal Chlamydia Trachomatis Research Articles

Prevalence of pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae among heterosexual men in Japan

Pharyngeal chlamydial and gonococcal infections can occur as a consequence of oral sex, and they also can be transmitted from the pharynx to the genital tract of sex partners. There have been many reports on the prevalence of pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in men who have sex with men; however, there have been few reports on the prevalence of these pathogens in the pharynges of heterosexual men. In this study, we determined the prevalence of pharyngeal C. trachomatis and N. gonorrhoeae in 42 heterosexual men diagnosed with urethritis. Pharyngeal swabs and first-voided urine specimens were tested using the Gen-Probe APTIMA Combo 2 transcription-mediated amplification assay. The prevalence of pharyngeal C. trachomatis and N. gonorrhoeae in patients with urethritis was 2.4 % (1/42) and 11.9 % (5/42), respectively. Among patients with either chlamydial or gonococcal urethritis, 9.1 % (1/11) and 25.0 % (5/20) had pharyngeal C. trachomatis or N. gonorrhoeae, respectively. Our results suggest that screening for pharyngeal colonization by N. gonorrhoeae and C. trachomatis using validated nucleic acid amplification tests should be performed in heterosexual men diagnosed with urethritis.

Should urologists care for the pharyngeal infection of Neisseria gonorrhoeae or Chlamydia trachomatis when we treat male urethritis?

Detection of Neisseria gonorrhoeae (NG) or Chlamydia trachomatis (CT) from the pharynx of women or men is not uncommon. However, there is no recommendation how urologists should care for the pharyngeal infection of men with urethritis in Japan. The aim of this study is to clarify the prevalence of NG or CT infection in the pharynx of men and to show a recommendation for urologists. The Japanese reports about the detection of NG or CT from the pharynx or the oral cavity of men in Japan are reviewed in the literature from 1990 to 2011. The prevalence of NG or CT in the pharynx was 4% or 6% in men who attended clinics, and 20% or 6% in men who were positive for NG or CT from genital specimens, respectively. Single 1-g dose ceftriaxone was recommended to treat pharyngeal NG, but no evidence was found for pharyngeal CT. There was not enough evidence for recommendation. However, when men with urethritis only caused by NG or CT are treated through the guideline of the Japanese Society of Sexually Transmitted Infection, we do not think additional tests or treatment for the pharynx are needed when a single 1-g dose ceftriaxone for gonococcal urethritis or a single 1- or 2- g dose azithromycin is prescribed for chlamydial urethritis in Japan.

Self-Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in the Human Immunodeficiency Virus Clinic—High Yields and High Acceptability

Despite antiretroviral therapy (ART), incident human immunodeficiency virus (HIV) continues to rise, and sexually transmitted infections (STI) are well known for their part in HIV transmission. National guidelines recommend routine STI screening in HIV-positive individuals, but despite this, reported uptake remains low. We implemented a nurse-led self-screening program for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in asymptomatic HIV patients. Self-collected samples were tested for CT and GC using the GenProbe Aptima Combo 2 assay. Clinical records were reviewed for ART history, CD4 T-cell count, and plasma viral load. A screening service evaluation questionnaire was handed out. During an 8-month period, 976 screens were performed. In all, 143 infections were detected which would have been missed without the screening program. Overall prevalence of infection among men who have sex with men was 17.4%: rectal CT and GC, 9.8% (56/571) and 4.2% (24/571), respectively; urethal CT and GC, 2.6% (16/605) and 1.3% (8/605), respectively; and pharyngeal CT and GC, 1.7% (10/589) and 3.9% (23/589), respectively. Among heterosexual men and women, the rates of CT were 2.1% (3/141) and 1.5% (3/201), and there was no GC. Transient viremia was observed at the time of STI diagnosis in 6 patients on ART. All men who have sex with men and most women found self-swabbing acceptable, and most patients indicated that they would like to be offered testing in future. These findings highlight the need for the introduction of similar screening approaches in HIV clinics. Self-collected specimens using sensitive and specific GC and CT nucleic acid amplification tests are a convenient and acceptable way of testing, and it may address some of the barriers to screening in this population.

Evaluation of Self-Collected Versus Clinician-Collected Swabs for the Detection of Chlamydia trachomatis and Neisseria gonorrhoeae Pharyngeal Infection Among Men Who Have Sex With Men

We evaluated self-sampling to detect pharyngeal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection among men who have sex with men attending a San Francisco STD clinic. The prevalence of pharyngeal NG and CT infection was 6.7% (32/480) and 1.3% (6/480), respectively. The percent agreement between self-collected and clinician-collected NG and CT specimens using nucleic acid amplification testing was 96.6% with a κ of 0.766 (95% confidence interval: 0.653-0.879) and 99.4% with a κ of 0.766 (95% confidence interval: 0.502-1.000), respectively. Acceptability was high among participants.

P1-S2.41 Sentinel survillance for pharyngeal chlamydia and gonorrhoea among men who have sex with men - San Francisco, 2010

BackgroundAlthough a potentially important route for transmission, limited data exist on the burden of pharyngeal chlamydia (CT) and gonorrhoea (GC) among men who have sex with men (MSM). The San...

P3-S1.19 Evaluation of the cobas® 4800 CT/NG test using clinician and self-collected vaginal swabs, cervical specimens in PreservCyt solution, and pharyngeal throat wash specimens

ObjectiveTo evaluate the limit of detection (LOD), inclusivity, exclusivity, and interfering substances of the cobas® 4800 CT/NG Test using vaginal, PreservCyt, and pharyngeal specimens.MethodsChlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG)...

O3-S3.04 Self-administered Neisseria gonorrheae and Chlamydia trachomatis testing in the pharynx and rectum among men who have sex with men in Washington, DC

BackgroundRecent studies have demonstrated a high prevalence of pharyngeal (P) and rectal (R) Neisseria gonorrheae (GC) and Chlamydia trachomatis (CT) infections among men who have sex with men (MSM), which...

Response to Tipple et al: Is screening for pharyngeal Chlamydia trachomatis warranted in high-risk groups?

Response to Tipple <i>et al</i>: Is screening for pharyngeal <i>Chlamydia trachomatis</i> warranted in high-risk groups?

Pharyngeal Chlamydia trachomatis is not uncommon any more

The significance of Chlamydia trachomatis (Ct) infection in the pharynx, and possible symptoms, are under discussion. Most studies have involved only homo/bisexual men. We report findings of pharyngeal Ct (PhCt) infections in patients with long-lasting throat discomfort and the prevalence of PhCt in genitally Ct-infected young people in a Swedish primary care setting. Sub-study 1 (SS1) included 48 persons aged 15-35 y, with pharyngeal discomfort for more than 14 days. Sub-study 2 (SS2) included 150 persons, aged 15-35 y, with genital Ct. Questionnaires concerning symptoms, sexual behaviour and sexual identity were completed for both groups. Samples for Ct testing were taken from the pharynx, and in SS1, samples were also collected to ascertain genital Ct. In SS1, 2 of 48 persons (4%) with pharyngeal discomfort had PhCt. In all, 35 of the 48 persons (73%) included in SS1 reported unprotected oral sex during the previous year. In SS2, 11 of 92 women (12%) and 4 of 58 men (7%) tested positive for PhCt. More women (94%) than men (83%) had given unprotected oral sex. Persons with PhCt had more symptoms from the upper respiratory tract (p = 0.04). Some primary care patients with long-lasting throat discomfort have a PhCt infection. PhCt infection is not uncommon in genitally infected sexually active people. More heterosexual women than heterosexual men had given unprotected oral sex and were infected by Ct in the pharynx. Thus, research on PhCt should not focus on homo/bisexual men only. Information about Ct should include the risk of contracting a PhCt infection as well as a gender perspective.

Is screening for pharyngeal Chlamydia trachomatis warranted in high-risk groups?

A recent survey reported that 36% of UK genitourinary medicine clinics offer testing for pharyngeal Chlamydia trachomatis (CT). Screening at this site is targeted at high-risk groups attending our centre, including female sex workers (FSWs) and male sex workers (MSWs). A total of 2406 patients were screened between November 2006 and October 2007. A retrospective case-note review was performed for positive cases. The prevalence of pharyngeal CT was 1.9% in both men and women. The mean number of sexual partners reported in the preceding three months was 168 and 56 for FSWs and MSWs, respectively. Lack of consistent condom use and high numbers of sexual partners identify this population as potential core transmitters of infection. While the British Association of Sexual Health and HIV (BASHH) guidelines do not recommend routine screening for pharyngeal CT, there may be a role in selected high-risk populations.

Occurrence of pharyngeal Chlamydia trachomatis is uncommon in patients with a suspected or confirmed genital infection

To evaluate how common pharyngeal Chlamydia trachomatis (CT) is among mainly heterosexual women and men with a confirmed or a highly suspicious genital infection having had recent unprotected active oral sex. Prospective observational study. Out-patient clinics for sexually transmitted infections in Stockholm. A total of 143 women and 138 men with a confirmed or suspected genital CT infection and a history of active oral sex. Pharyngeal samples from men and women in the study population were analyzed for the presence of CT. Number of positive CT in pharyngeal samples in relation to positive CT in genital samples. Of the women, 9/128 (7.0%) were positive in the pharyngeal samples. None were exclusively positive in the pharynx. Three of 110 men (2.7%) had pharyngeal involvement. One man was positive in the pharynx as well as in the urine sample, and two men were exclusively pharyngeal CT positive. The finding of CT in the pharynx is not common in spite of the presence of a genital infection and a history of active oral sex.

Role of remodeling of pharyngeal cavity in velopharyngoplasty for treating obstructive sleep apnea hypopnea syndrome and its related anatomic study

To investigate a new velopharyngoplasty (VPP), including its anatomic character and its mechanism of remodeling of oral-pharynx cavity for treating obstructive sleep apnea hypopnea syndrome (OSAHS). Two cases of soft palate were dissected in adult male cadavers. And the model of VPP was established to further observe its technical characteristics. A total of 85 OSAHS patients were studied by PSG. And all cases received velopharyngoplasty (VPP) and follow-ups. Ten cases were selected for CT scanning of palatal pharyngeal cavity and CT workstation was employed for imaging measurements. The measured parameters of pharyngeal palate included soft palate length, maximal thickness of soft palate, soft palate to posterior pharyngeal edge of free space, parapharyngeal space (distance between tonsils), uvula length, width of uvula base, velopharyngeal cross-sectional area and cross-sectional area of angina. All these parameters had a significantly difference between pre-operation and post-operation [(37.8 +/- 5.5) mm vs (27.0 +/- 4.1) mm, (13.3 +/- 2.2) mm vs (9.3 +/- 2.5) mm, (7.1 +/- 2.8) mm vs (10.3 +/- 1.7) mm, (45.2 +/- 25.5) mm(2) vs (135.3 +/- 26.4) mm(2), (2.0 +/- 21.8) mm(2) vs (208.4 +/- 15.9) mm(2)]; however there was no significant difference in retropharyngeal wall thickness [(6.8 +/- 2.9) mm vs (7.0 +/- 2.5) mm]. VPP remodels palatopharyngeal region through the design of incision, the management of pharyngopalatine arch tonsillectomy and the suture of laterapharynx mucisae. This surgical procedure can obviously upgrade the velum platinum, enlarge the oropharyngeal airway effectively. It is a significant modified-UPPP surgical technique.

Incidence and Treatment Outcomes of PharyngealNeisseria gonorrhoeaeandChlamydia trachomatisInfections in Men Who Have Sex with Men: A 13‐Year Retrospective Cohort Study

This study investigated the incidence and treatment outcomes of pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis cases at a Canadian clinic that mainly serves men who have sex with men. All patients with pharyngeal N. gonorrhoeae and C. trachomatis infections detected from 1 January 1995 through 31 December 2007 were identified. Original and test-of-cure N. gonorrhoeae culture isolates were compared using antibiotic susceptibility testing and N. gonorrhoeae multiantigen sequence typing. One hundred seventy-eight cases of pharyngeal N. gonorrhoeae infection and 97 cases of pharyngeal C. trachomatis infection were identified, primarily by culture methods. The mean incidence was 1.62 and 0.81 cases per 1000 visits per year for N. gonorrhoeae and C. trachomatis infection, respectively. Poisson regression modeling demonstrated a statistically significant surge of pharyngeal N. gonorrhoeae cases in 2007 after controlling for seasonal and long-term oscillation and long-term linear trends. Among patients with pharyngeal N. gonorrhoeae and C. trachomatis infection, 60.2% and 84.3%, respectively, would have been missed by relying on urine and urethral testing. Nine percent of patients with pharyngeal N. gonorrhoeae and 4.3% of patients with pharyngeal C. trachomatis infection who underwent test-of-cure procedures had at least 1 positive result. Antibiograms were not different in 8 of 10 pretreatment and posttreatment N. gonorrhoeae isolate pairs. N. gonorrhoeae multiantigen sequence typing results were identical in 2 of these cases. Public health records documented abstinence in both individuals. Nine percent of cases with pharyngeal N. gonorrhoeae and 4.3% of cases with pharyngeal C. trachomatis infection that underwent tests of cure had positive results. Available typing results suggest antibiotic treatment failure rather than reinfection. Specific antibiotic treatment regimens for pharyngeal N. gonorrhoeae and C. trachomatis infections need to be developed and formally evaluated.

Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in pharyngeal and rectal specimens using the BD Probetec ET system, the Gen-Probe Aptima Combo 2 assay and culture

Objectives: This study compared the sensitivity and specificity of culture and two nucleic acid amplification tests (NAATs): the BD Probetec ET system (PT) and the Aptima Combo 2 (AC2) in...

Prevalence, incidence and risk factors for pharyngeal chlamydia in the community based Health in Men (HIM) cohort of homosexual men in Sydney, Australia

To determine the prevalence, incidence and risk factors for pharyngeal Chlamydia trachomatis in the community based Health in Men (HIM) cohort of HIV negative homosexual men in Sydney, Australia. From January 2003, all HIM participants were offered annual screening for pharyngeal chlamydia using BD ProbeTec nucleic acid amplification testing (NAAT). Detailed sexual behavioural data were collected every 6 months, and risk factors for infection and hazard ratios were calculated using Cox regression. Among 1427 participants enrolled, the prevalence of pharyngeal chlamydia on initial testing was 1.06% and the incidence rate was 0.58 per 100 person-years. More than 50% of all infections were identified on baseline testing and 68% of men with pharyngeal infection had no evidence of concurrent anogenital chlamydia. There was no association of pharyngeal chlamydia with sore throat. Infection was significantly associated with increasing frequency of receptive penile-oral sex with ejaculation with casual partners (p = 0.009), although approximately half of infections occurred in participants not reporting this risk behaviour. Neither kissing nor oro-anal practices were associated with infection. The incidence of pharyngeal chlamydia infection in the HIM study was relatively low; however, the relatively high prevalence on baseline testing compared to incidence suggests a long duration of infection. Occasional screening for pharyngeal chlamydia in homosexual men who frequently practise receptive oral sex with ejaculation may be warranted.

Infección profunda del cuello por Streptococcus grupo B en un paciente diabético: Caso clínico

We report a 47 year-old diabetic male, admitted due to metabolic decompensation, malaise, purulent pharyngeal discharge and a mass in the posterior cervical region. Blood glucose was 270 mg/dl, a nasopharyngoscopy showed a pharyngeal phlegmon and CT scan confirmed the presence of a phlegmon in the retropharyngeal region. He was treated with sodium penicillin, cloxacillin and ceftriazone and the phlegmon was drained surgically. The culture of the purulent discharge gave growth to a Group B Streptococcus. The evolution was favorable and the patient completed seven days with intravenous antimicrobials and additional seven days with oral ampicillin/sulbactam.

Chlamydia trachomatis in the Throat: Is Testing Necessary?

Chlamydia trachomatis (CT) can cause infertility and is the most common sexually transmitted infection (STI) of bacterial origin in Europe. Surveys in seven countries estimated a population prevalence of 1.4-3.0 % in people 18 to 44 years. Approximately 87% of those diagnosed in Sweden are 15-29 years. Since 1997, with the exception of 2009-2010, despite all efforts, CT has increased steadily in many European countries including Sweden. That made us investigate risk factors associated with catching STIs, especially CT. In Sweden partner notification is mandatory by law when a patient is diagnosed with CT. Centralised partner notification, performed by a few experienced counsellors, and evaluation of the sexual history for at least 12 months back in time, shows superior results compared to other studies. Phone-interviews are a good option in remote areas. “The Vasterbotten model” for partner notification fulfils these criteria and our evaluation has functioned as a model for changing recommendations of partner notification in Sweden. Preventing CT by primary prevention such as information and counselling is, however, still of great importance. We investigated whether it was necessary to test for CT in the throat. We found that patients testing positive for pharyngeal CT neither had more symptoms or signs nor a sexual history that differed from others. We therefore believe that we will find most or all of these patients by conventional testing of urine and cervical/vaginal samples. We wanted to further identify risk factors among patients attending a clinic for sexually transmitted infections to enable individualized care depending on risk. None or inconsistent use of condoms with new/temporary partners in combination with having at least one new/temporary partner within the past 6 months could identify persons with risk behaviour and at increased risk of CT (re)infection. Additional information about whether the condom was used during the whole intercourse did not add any risk of infection. A drop-in reception is a good contribution to an opportunistic screening approach. The rate of CT infected is high and the clinic attracts men and individuals ≥25 years old at risk of infection, groups which usually have a reduced test rate. The mean age was 28 years and 58% of the patients were men. The figure of correct condom usage is very low indicating the need for risk reducing counselling also in this grown-population. Among adult STI patients anxiety was common and depression uncommon. Neither was linked to high risk sexual behaviour nor ongoing CT infection. Hazardous alcohol consumption, however, was common and linked to anxiety and high risk sex. We conclude that preventive work can not only focus on STI prevention, but must consider the high frequency of hazardous alcohol consumption, which probably is contributing to sexual risk behaviour.

Usefulness of oral wash specimens for detecting Chlamydia trachomatis from high‐risk groups in Japan

Orogenital sex is recognized as a route for the transmission of Chlamydia trachomatis (CT) which thus causes male chlamydial urethritis. Patients with a pharyngeal CT infection have no gross lesions, but CT was tested by pharyngeal swabs. In this study, the usefulness of oral wash specimens for detecting CT was compared to that of swab specimens. In addition, oral wash specimens were also used to screen for CT pharyngeal infection. Eighteen female commercial sex workers in whom CT was detected from pharyngeal swabs were re-examined using both methods. The positive rate for CT was 44% by swabs and 61% by oral wash specimens. Forty-eight male students with CT-positive urine were also screened for pharyngeal CT infection. The positive rates were 6% by swabs and 10% by oral wash specimens. Our findings therefore indicate that oral wash specimens more effectively detected pharyngeal CT infection than pharyngeal swabs.

Análisis clínico y funcional de los resultados de la uvulopalatofaringoplastia a largo plazo

In order to evaluate the clinical and functional effectiveness of uvulopalatopharyngoplasty (UPPP) in chronic roncopathy, we studied the subjective improvement of operated patients and compared to pulsioximetry findings before and after surgery. A follow-up was made on 72 patients entitled of chronic roncopathy –51 with obstructive sleep apnea syndrome (OSAS) and 21 with simple snoring-, for a mean period of time of 41 months. Preoperatory study included on ENT exploration, fibre optic endoscopy, Müller maneuver, pharyngeal CT, value of daytime sleepiness with Epworth’s scale, espirometry and pulsioximetry, and the postoperatory study included of pulsioximetry and a health questionnaire over snoring and daytime sleepiness. Snoring improved or disappeared in 13 of 21 patients (61,8%), and daytime sleepiness did it in 26 of 39 (66,6%). Therapeutic failure in snoring was mainly due to an increase in the body mass index. After UPPP in OSAS, only 21 patients (41.1%) showed all positive response criteria (decrease into ODI ≥50% or in absolute values <6, CT 90% <1%, and SaO2 Min ≥85%). UPPP failed in long term evaluation in the rest of individuals. Patient selection is mandatory to optimize clinical response of UPPP for snoring, whitot OSAS success depends on body mass index, respiratory disturbances ratios and the eventual presence of another upper airways collapses below velopharyngeal segment.

Upper Airway Changes in Snorers and Mild Sleep Apnea Sufferers After Uvulopalatopharyngoplasty (UPPP)

We used upper airway (UA) imaging in 20 patients to determine (1) whether an effective enlargement of the UA is obtained after uvulopalatopharyngoplasty (UPPP), and (2) whether UA modifications explain the results of such surgery. Cephalometric measurements were made to assess the posterior airway space, the length and width of the soft palate, and the distance between the hyoid bone and the mandibular plane. Pharyngeal CT measured the airway cross-sectional area (CSA) at each 10-mm slice from 10 mm above (-10) to 40 mm below (+40) the hard palate. Polysomnography was performed before and after surgery (10+/-10 [SD] months). Good responders were defined by an apnea-hypopnea index (AHI) of <10 postsurgery or, in patients in whom AHI was initially <10, a reduction of AHI >50% of the initial AHI. Twenty patients (age=45+/-11 years) were studied. For the whole group, the mean body mass index (26+/-4 kg/m2) and AHI (14+/-13 vs 18+/-16/h) were unchanged after UPPP. The results of the surgery were mediocre with 7 good responders (35%) and 13 nonresponders (65%) defined by polysomnographic criteria. The only changes on UA imaging for the group as a whole after UPPP were decrease in length (40+/-6 vs 29+/-5 mm, p< or =0.0006) and increase in width of the soft palate (11.5+/-2.7 vs 13.6+/-3.5 mm, p< or =0.006). The increase or decrease in minimal CSA at the oropharyngeal (OP) level after UPPP was significantly correlated with the change in AHI (r=-0.54, p<0.02). Moreover, the changes in CSA obtained at the OP level were significant only in the patients who responded favorably to UPPP (7 vs 13 nonresponders). Postoperative OP enlargement is associated with a good outcome of UPPP. Persistent narrowing in nonresponders could be due to the increase in soft palate width after surgery.