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. 2025 Oct 1;52(10):597-602.
doi: 10.1097/OLQ.0000000000002154. Epub 2025 Aug 7.

Chlamydia and Gonorrhea Infections in Genital and Extragenital Samples Among Men and Women

Kristal J Aaron  1 , Charlotte A Gaydos  2 , Edward W Hook 3rd  1 , Max Chernesky  3 , Jeanne Moncada  4 , Stephanie N Taylor  5 , Harold C Wiesenfeld  6 , Kenneth H Mayer, Matthew R Golden, Alexander Boutwell  1 , Barbara Van Der Pol  1
Affiliations

Chlamydia and Gonorrhea Infections in Genital and Extragenital Samples Among Men and Women

Kristal J Aaron et al. Sex Transm Dis. .

Abstract

Background: For people who have anal and/or oral sex, many programs recommend genital and extragenital (defined here as anorectal and oropharyngeal) screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) to identify all potential sites of infection.

Methods: We assessed genital and extragenital CT and NG prevalence among people reporting extragenital sexual exposure.

Results: Among 343 gay and bisexual men who reported sex with men (GBMSM), 42 (12.2%) had CT with positivity of 3.5%, 9.3%, and 1.8% in the genital, anal, and oral samples, respectively. In this same group, 55 (16.0%) had NG with positivity of 5.2%, 8.5%, and 7.6% in the genital, anal, and oral samples, respectively. If only genital screening had been performed, 71.4% of CT infections and 67.3% of NG infections in GBMSM would have gone undetected. Among 96 men who only have sex with women (MSW), 10 (10.4%) had chlamydial infection-all detected in genital samples with no extragenital infections detected. Nine gonococcal infections (9.4%) were detected in MSW, with positivity of 6.3%, 2.1%, and 3.1% in the genital, anal, and oral samples, respectively. If only genital testing had been performed, no CT infections would have been missed among MSW; however, 33.3% of NG infections would have been missed. Among 329 cisgender women, 35 (10.6%) had CT with positivity of 7.9%, 6.1%, and 1.8% in the genital, anal, and oral samples, respectively. In the same group, 17 (5.2%) had NG with positivity of 4.0%, 2.1%, and 2.4% in the genital, anal, and oral samples, respectively. Among these women, 25.7% and 23.5% of CT and NG infections, respectively, would not have been detected.

Conclusions: The increased case finding when including extragenital testing for GBMSM and women was confirmed in this analysis. However, the benefit-cost ratio and the clinical or public health value of extragenital screening in these different populations require further study.

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Conflict of interest statement

Conflict of Interest and Sources of Funding: K.J.A., M.C., J.M., S.N.T., H.C.W., A.B., have no disclosures to report. C.A.G. receives grant support to her institution, consulting fees, and/or honoraria from Alpha Sense Experts, Binx Health Care. E.W.H. receives consulting fees and/or honoraria from VISBY Diagnostics, Innovia Therapeutics, and the Global Antibiotic Research and Development Project (GARDP). K.H.M. has received unrestricted research grants from GSK and Moderna Inc to study STI vaccines. M.R.G. receives research support to his institution from GSK, Hologic, and SpeeDx. B.V.D.P. receives support to her institution, and consulting fees and/or honoraria from Abbott, BD, BioFire, Cepheid, Detect, Hologic, MagIC, Preventx, Roche, Sherlock, and Visby.

References

    1. Sexually Transmitted Disease Surveillance, 2022. Division of STD prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention.
    1. Habel MA, Leichliter JS, Dittus PJ, et al. Heterosexual anal and oral sex in adolescents and adults in the United States, 2011–2015. Sex Transm Dis 2018; 45:775–782.
    1. Detels R, Green AM, Klausner JD, et al. The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries. Sex Transm Dis 2011; 38:503–509.
    1. Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59(RR-12):1–110.
    1. Centers for Disease Control and Prevention. US Public Health Service: Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—2021 Update Clinical Practice Guideline. Available at: https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf

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