title: Patterns of Extragenital Chlamydia and Gonorrhea in Women and Men Who Have Sex With Men Reporting a History of Receptive Anal Intercourse.
abstract: BACKGROUND
  Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in men who have sex with men is risk based. Despite high frequencies of oral and receptive anal intercourse (RAI) among women, extragenital screening is not recommended.
  
  
  METHODS
  Women (n = 175) and men who have sex with men (n = 224) primarily recruited from a sexually transmitted infection clinic reporting a lifetime history of RAI completed a structured questionnaire and clinician-collected swab samples from the rectum, pharynx, vagina (women), and urine (men). CT and GC were detected using 2 commercial nucleic acid amplification tests (Aptima Combo 2; Hologic, Inc, Bedford, MA; Xpert CT/NG, Cepheid Innovation, Sunnyvale, CA).
  
  
  RESULTS
  The median age of the population was 26 years, 62% were white, and 88% were enrolled from a sexually transmitted disease clinic. Men were more likely than women to have GC (22.8% vs. 3.4%) and CT (21.9% vs. 12.6%). In men versus women, GC was detected in 16.5% versus 2.3% of pharyngeal swabs, 11.6% versus 2.3% of rectal swabs, and 5.4% versus 2.9% of urine samples or vaginal swabs. C. trachomatis was detected in 2.2% versus 1.7% of pharyngeal swabs, 17.4% versus 11.4% of rectal swabs, and 4.5% versus 10.3% for urogenital sites in men versus women. Overall 79.6% of CT and 76.5% of GC in men and 18.2% of CT and 16.7% of GC in women were detected only in the pharynx or rectum.
  
  
  CONCLUSIONS
  Reliance on urogenital screening alone misses most of GC and CT in men and more than 15% of infections in women reporting RAI.
authors.affiliation: From the *University of Pittsburgh, Pittsburgh, PA; and †Magee-Womens Research Institute, Pittsburgh, PA.
authors.forename: Claire S
authors.initials: CS
authors.lastname: Danby
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cosentino
authors.forename: Lorna K
authors.initials: LK
authors.lastname: Rabe
authors.forename: Carol L
authors.initials: CL
authors.lastname: Priest
authors.forename: Khrystine C
authors.initials: KC
authors.lastname: Damare
authors.forename: Ingrid S
authors.initials: IS
authors.lastname: Macio
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Meyn
authors.forename: Harold C
authors.initials: HC
authors.lastname: Wiesenfeld
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Hillier
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000235:genetics / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques; D010614:Pharynx / Q000382:microbiology; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014621:Vagina / Q000382:microbiology; D055815:Young Adult