Clinicians Could Miss Some STI Infections Without Extragenital Screening
In this Q&A, two researchers discuss their recent study on how annual screening for urethral and rectal chlamydia and gonorrhea could be improved with extragenital screening, based on risk factors. The study population included men and women at Louisiana’s Parish Health Units.1
Bruce W. Furness, MD, MPH, of the CDC’s Division of STD Prevention of the District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, and Mohammad M. Rahman, MBBS, MPH, PhD, of the Louisiana Department of Health, STD/HIV/Hepatitis Program, provided answers via email. The following transcript has been lightly edited for length and clarity.
CTU: Please explain why your study focused on extragenital rectal chlamydia and gonorrhea screening. Why is this important, particularly for female patients?
Rahman: Over the past several years, Louisiana consistently has had high rates of chlamydia (CT) and gonorrhea (NG). Concerns about the possibility of missing infections in exposed persons led the Louisiana Office of Public Health to institute routine extragenital screening of patients attending parish health units, based on reported sites of sexual exposure.
Furness: Although there are currently no recommendations in the United States to routinely screen women at extragenital sites, we sought to assess the burden of rectal and pharyngeal infections in this population across genders and gender of sex partner. One concern about missed or undiagnosed gonorrhea infection is this may have the potential to increase the risk of HIV acquisition.
CTU: What were your findings?
Rahman: We screened 38,507 female patients at 11 Louisiana Parish health units between 2016 and 2019. Rectal chlamydia positivity was 11.6%, pharyngeal chlamydia positivity was 2%, while rectal gonorrhea positivity among female patients was 4.6%. Pharyngeal gonorrhea positivity was 3.8%. If the Louisiana Parish Health Units had not conducted extragenital screening in women, then they would have missed 15.3% of gonorrhea infections and 4.4% of chlamydia infections in female patients.
CTU: How might reproductive healthcare facilities, OB/GYNs, and clinicians improve their care of women and nonbinary or trans men by adding extragenital STI screening to recommendations for patients? What risk factors would suggest this would be an important screening for that population?
Furness: The findings of this study do not support expanding routine extragenital STI screening for all women, but they underscore that reproductive healthcare facilities, OB/GYNs, and clinicians can improve their care of women and nonbinary or trans men by conducting a comprehensive sexual history at every visit, including assessing partners and sexual practices. CDC recommends rectal chlamydial testing and pharyngeal and rectal gonorrhea screening be considered in females based on reported sexual behaviors and exposure. Additionally, screening exposed anatomical sites, such as the throat and rectum, might lead to increased identification of STIs among trans men who do not use their genitals for sex.
Studies indicate women who have sex with men and women might be at increased risk for STIs based on reported risk behaviors. In this study, among women, the highest number of extragenital chlamydia and gonorrhea infections that would have been missed with urogenital only screening was among bisexual women. More studies are required to assess if routine extragenital screening among bisexual women is beneficial. Additionally, more studies are needed to assess the significance of extragenital STIs among women.
- Rahman MM, Johnson C, Taylor SN, et al. Extragenital sexually transmitted infection testing among Louisiana Parish health units, 2016-2019. Sex Transm Dis 2023;50: 274-279.
In this Q&A, two researchers discuss their recent study on how annual screening for urethral and rectal chlamydia and gonorrhea could be improved with extragenital screening, based on risk factors. The study population included men and women at Louisiana’s Parish Health Units.
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