Added Value of Extragenital Sexually Transmitted Infection Testing in "IWantTheKit" Program Users.
Journal
Sexually transmitted diseases
ISSN: 1537-4521
Titre abrégé: Sex Transm Dis
Pays: United States
ID NLM: 7705941
Informations de publication
Date de publication:
01 03 2023
01 03 2023
Historique:
pmc-release:
01
03
2024
pubmed:
3
2
2023
medline:
9
2
2023
entrez:
2
2
2023
Statut:
ppublish
Résumé
The 2021 Centers for Disease Control and Prevention sexually transmitted infection treatment guidelines recommend extragenital testing for gonorrhea and chlamydia in men who have sex with men and for women based on reported behaviors and exposures. The "IWantTheKit (IWTK)" program is a free online platform for specimen self-collection and mail-in for combined chlamydia/gonorrhea testing. We sought to assess the additional diagnostic value of extragenital testing compared with genital testing only for chlamydia/gonorrhea and determine factors associated with a positive extragenital test result among IWTK users. From August 2013 to January 2022, 7612 unique IWTK users returned swabs for testing; 3407 (45%) users requested both genital and extragenital tests and were included in this analysis. Descriptive statistics were summarized for demographic characteristics, reported behaviors, and genital and extragenital test results, and data were stratified by gender and age group. A logistic regression model was used to estimate associations between factors and extragenital sexually transmitted infection positivity. Chlamydia positivity rates were 4.7%, 2.4%, and 1.5% at genital, extragenital, and both sites, respectively; for gonorrhea, 0.4%, 1.1%, and 0.4% were positive at those sites, respectively. Among women, age 25 years and younger was significantly associated with extragenital chlamydia (odds ratio [OR], 4.0; P = 0.010). Being in high-risk quiz score group was associated with extragenital chlamydia (OR, 2.6; P = 0.005) and extragenital gonorrhea in men and women (OR, 8.5; P = 0.005). Extragenital testing detected additional chlamydia and gonorrhea cases in the IWTK user population that would have been missed by genital-only testing, especially for women younger than 25 years and people reported to be at high risk.
Sections du résumé
BACKGROUND
The 2021 Centers for Disease Control and Prevention sexually transmitted infection treatment guidelines recommend extragenital testing for gonorrhea and chlamydia in men who have sex with men and for women based on reported behaviors and exposures. The "IWantTheKit (IWTK)" program is a free online platform for specimen self-collection and mail-in for combined chlamydia/gonorrhea testing. We sought to assess the additional diagnostic value of extragenital testing compared with genital testing only for chlamydia/gonorrhea and determine factors associated with a positive extragenital test result among IWTK users.
METHODS
From August 2013 to January 2022, 7612 unique IWTK users returned swabs for testing; 3407 (45%) users requested both genital and extragenital tests and were included in this analysis. Descriptive statistics were summarized for demographic characteristics, reported behaviors, and genital and extragenital test results, and data were stratified by gender and age group. A logistic regression model was used to estimate associations between factors and extragenital sexually transmitted infection positivity.
RESULTS
Chlamydia positivity rates were 4.7%, 2.4%, and 1.5% at genital, extragenital, and both sites, respectively; for gonorrhea, 0.4%, 1.1%, and 0.4% were positive at those sites, respectively. Among women, age 25 years and younger was significantly associated with extragenital chlamydia (odds ratio [OR], 4.0; P = 0.010). Being in high-risk quiz score group was associated with extragenital chlamydia (OR, 2.6; P = 0.005) and extragenital gonorrhea in men and women (OR, 8.5; P = 0.005).
CONCLUSIONS
Extragenital testing detected additional chlamydia and gonorrhea cases in the IWTK user population that would have been missed by genital-only testing, especially for women younger than 25 years and people reported to be at high risk.
Identifiants
pubmed: 36729630
doi: 10.1097/OLQ.0000000000001743
pii: 00007435-202303000-00003
pmc: PMC10104591
mid: NIHMS1852803
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
138-143Subventions
Organisme : NIBIB NIH HHS
ID : U54 EB007958
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI068613
Pays : United States
Informations de copyright
Copyright © 2022 American Sexually Transmitted Diseases Association. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest and Sources of Funding: None declared.
Références
Center for Disease Control and Prevention. STD statistics prevalence 2020 at a glance. 2021.
Maryland Department of Health. Sexually Transmitted Infections 2019 Annual Report. 2019.
Centers for Disease Control and Prevention STD Surveillance. 2020. Available at: https://www.cdc.gov/std/statistics/2020/default.htm .
Assaf RD, Cunningham NJ, Adamson PC, et al. High proportions of rectal and pharyngeal chlamydia and gonorrhoea cases among cisgender men are missed using current CDC screening recommendations. Sex Transm Infect 2022; 98:586–591.
Unemo M, Golparian D, Hestner A. Ceftriaxone treatment failure of pharyngeal gonorrhoea verified by international recommendations, Sweden, July 2010. Euro Surveill 2011; 16:19792.
Barbee LA, Khosropour CM, Dombrowksi JC, et al. New human immunodeficiency virus diagnosis independently associated with rectal gonorrhea and chlamydia in men who have sex with men. Sex Transm Dis 2017; 44:385–389.
Chow EP, Camilleri S, Ward C, et al. Duration of gonorrhoea and chlamydia infection at the pharynx and rectum among men who have sex with men: A systematic review. Sex Health 2016; 13:199–204.
Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. Screening Recommendations and Considerations.
Tuddenham S, Hamill MM, Ghanem KG. Diagnosis and treatment of sexually transmitted infections: A review. JAMA 2022; 327:161–172.
Abara WE, Llata EL, Schumacher C, et al. Extragenital gonorrhea and chlamydia positivity and the potential for missed extragenital gonorrhea with concurrent urethral chlamydia among men who have sex with men attending sexually transmitted disease clinics—Sexually Transmitted Disease Surveillance Network, 2015–2019. Sex Transm Dis 2020; 47:361–368.
Huxta RA, Soniyi O, Halbritter A, et al. Extragenital screening of Chlamydia trachomatis and Neisseria gonorrhoeae among women in the college health setting. Sex Transm Dis 2021; 48:643–647.
Allen C, Fairley CK, Chen MY, et al. Oropharyngeal gonorrhoea infections among heterosexual women and heterosexual men with urogenital gonorrhoea attending a sexual health clinic in Melbourne, Australia. Clin Microbiol Infect 2021; 27:1799–1804.
Jann JT, Cunningham NJ, Assaf RD, et al. Evidence supporting the standardisation of extragenital gonorrhoea and chlamydia screenings for women. Sex Transm Infect 2021; 97:601–606.
Chan PA, Robinette A, Montgomery M, et al. Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae : A review of the literature. Infect Dis Obstet Gynecol 2016; 2016:5758387.
www.iwantthekit.org .
Melendez JH, Hamill MM, Armington GS, et al. Home-based testing for sexually transmitted Infections: Leveraging online resources during the COVID-19 pandemic. Sex Transm Dis 2021; 48:e8–e10.
Melendez JH, Gilliams EA, Yu T, et al. Rapid uptake of testing for chlamydia, gonorrhea, and HIV from an online platform, April–October 2020. Am J Public Health 2022; 112:985–989.
Gaydos CA, Jett-Goheen M, Barnes M, et al. Use of a risk quiz to predict infection for sexually transmitted infections: A retrospective analysis of acceptability and positivity. Sex Transm Infect 2016; 92:44–48.
Patel AV, Gaydos CA, Jett-Goheen M, et al. Assessing association between IWantTheKit risk quiz tool and sexually transmitted infection positivity in male users for sexually transmitted infection screening. Int J STD AIDS 2018; 29:122–127.
R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing, 2022. Available at: https://www.R-project.org/ .
Tao G, Hoover KW, Nye MB, et al. Infrequent testing of women for rectal chlamydia and gonorrhea in the United States. Clin Infect Dis 2018; 66:570–575.
Gunaratne K, Gold WL, Wu PE. Disseminated gonococcal infection: The importance of testing all mucosal sites. CMAJ 2020; 192:E652.
Andersson N, Boman J, Nylander E. Rectal chlamydia—Should screening be recommended in women?Int J STD AIDS 2017; 28:476–479.
O'Leary A, DiNenno E, Honeycutt A, et al. Contribution of anal sex to HIV prevalence among heterosexuals: A modeling analysis. AIDS Behav 2017; 21:2895–2903.
Ding A, Challenor R. Rectal chlamydia in heterosexual women: More questions than answers. Int J STD AIDS 2014; 25:587–592.
Trebach JD, Chaulk CP, Page KR, et al. Neisseria gonorrhoeae and Chlamydia trachomatis among women reporting extragenital exposures. Sex Transm Dis 2015; 42:233–239.
Man OM, Ramos WE, Vavala G, et al. Optimizing screening for anorectal, pharyngeal, and urogenital Chlamydia trachomatis and Neisseria gonorrhoeae Infections in at-risk adolescents and young adults in New Orleans, Louisiana and Los Angeles, California, United States. Clin Infect Dis 2021; 73:e3201–e3209.
Jordan NN, Jett-Goheen M, Hsieh YH, et al. Detection of three sexually transmitted infections by anatomic site: Evidence from an Internet-based screening program. Sex Transm Dis 2020; 47:243–245.
Ladd J, Hsieh YH, Barnes M, et al. Female users of internet-based screening for rectal STIs: Descriptive statistics and correlates of positivity. Sex Transm Infect 2014; 90:485–490.