title: Evaluation of sexual history-based screening of anatomic sites for chlamydia trachomatis and neisseria gonorrhoeae infection in men having sex with men in routine practice.
abstract: BACKGROUND
  Sexually transmitted infection (STI) screening programmes are implemented in many countries to decrease burden of STI and to improve sexual health. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae has a prominent role in these protocols. Most of the screening programmes concerning men having sex with men (MSM) are based on opportunistic urethral testing. In The Netherlands, a history-based approach is used. The aim of this study is to evaluate the protocol of screening anatomic sites for C. trachomatis and N. gonorrhoeae infection based on sexual history in MSM in routine practice in The Netherlands.
  
  
  METHODS
  All MSM visiting the clinic for STI in The Hague are routinely asked about their sexual practice during consulting. As per protocol, tests for urogenital, oropharyngeal and anorectal infection are obtained based on reported site(s) of sexual contact. All consultations are entered into a database as part of the national STI monitoring system. Data of an 18 months period were retrieved from this database and analysed.
  
  
  RESULTS
  A total of 1455 consultations in MSM were registered during the study period. The prevalence of C. trachomatis and N. gonorrhoeae per anatomic site was: urethral infection 4.0% respectively and 2.8%, oropharynx 1.5% and 4.2%, and anorectum 8.2% and 6.0%. The majority of chlamydia cases (72%) involved a single anatomic site, which was especially manifest for anorectal infections (79%), while 42% of gonorrhoea cases were single site. Twenty-six percent of MSM with anorectal chlamydia and 17% with anorectal gonorrhoea reported symptoms of proctitis; none of the oropharyngeal infections were symptomatic. Most cases of anorectal infection (83%) and oropharyngeal infection (100%) would have remained undiagnosed with a symptom-based protocol.
  
  
  CONCLUSIONS
  The current strategy of sexual-history based screening of multiple anatomic sites for chlamydia and gonorrhoea in MSM is a useful and valid guideline which is to be preferred over a symptom-based screening protocol.
authors.affiliation: The Hague Municipal Health Services, STI clinic, The Hague, The Netherlands. rph.peters@gmail.com
authors.forename: Remco P H
authors.initials: RP
authors.lastname: Peters
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Verweij
authors.forename: Noëmi
authors.initials: N
authors.lastname: Nijsten
authors.forename: Sander
authors.initials: S
authors.lastname: Ouburg
authors.forename: Johan
authors.initials: J
authors.lastname: Mutsaers
authors.forename: Casper L
authors.initials: CL
authors.lastname: Jansen
authors.forename: A Petra
authors.initials: AP
authors.lastname: van Leeuwen
authors.forename: Servaas A
authors.initials: SA
authors.lastname: Morré
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000382:microbiology; D002690:Chlamydia Infections / Q000175:diagnosis*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D006069:Gonorrhea / Q000175:diagnosis*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D009426:Netherlands; D009960:Oropharynx / Q000382:microbiology; D012680:Sensitivity and Specificity; D014521:Urethra / Q000382:microbiology; D055815:Young Adult