Trebach Joshua D, Chaulk C Patrick, Page Kathleen R, Tuddenham Susan, Ghanem Khalil G
From the *Johns Hopkins University School of Medicine, Baltimore, MD; and †Baltimore City Health Department, Baltimore, MD.
Sex Transm Dis. 2015 May;42(5):233-9. doi: 10.1097/OLQ.0000000000000248.
The Centers for Disease Control and Prevention recommends pharyngeal screening of Neisseria gonorrhoeae (GC) and rectal screening of GC and Chlamydia trachomatis (CT) in HIV-infected and at-risk men who have sex with men (MSM). There are currently no recommendations to routinely screen women at extragenital sites. We define the prevalence of extragenital GC and CT in women attending 2 urban sexually transmitted disease clinics in Baltimore City and compare it with the prevalence of extragenital infections in MSM and men who have sex with women.
All patients who reported extragenital exposures in the preceding 3 months, who presented for care between June 1, 2011, and May 31, 2013, and who were tested for GC and CT using nucleic acid amplification tests at all sites of exposure were included in the analyses. We used logistic regression models to identify risk factors for extragenital infections.
A total of 10,389 patients were included in this analysis (88% African American; mean age, 29 years; 42% women; 7% MSM; 2.5% HIV infected). The prevalence estimates of any extragenital GC and CT were as follows: 2.4% GC and 3.7% CT in women, 2.6% GC and 1.6% CT in men who have sex with women, and 18.9% GC and 11.8% CT in MSM. Among women, 30.3% of GC infections and 13.8% of CT infections would have been missed with urogenital-only testing. Unlike MSM, age ≤ 18 years was the strongest predictor of extragenital infections in women.
Although the prevalence of extragenital gonorrhea and chlamydia is highest in MSM, a significant number of GC and CT infections in young women would be missed with genital-only testing. Cost-effectiveness analyses are needed to help inform national guidelines on extragenital screening in young women.
美国疾病控制与预防中心建议，对感染HIV及有感染风险的男男性行为者（MSM）进行咽部淋病奈瑟菌（GC）筛查，以及直肠GC和沙眼衣原体（CT）筛查。目前尚无对女性进行生殖器外部位常规筛查的建议。我们确定了在巴尔的摩市两家城市性传播疾病诊所就诊的女性生殖器外GC和CT的患病率，并将其与MSM及异性性行为男性的生殖器外感染患病率进行比较。
纳入所有在2011年6月1日至2013年5月31日期间前来就诊、报告在过去3个月有生殖器外暴露史且在所有暴露部位均接受了GC和CT核酸扩增检测的患者。我们使用逻辑回归模型来确定生殖器外感染的危险因素。
本分析共纳入10389例患者（88%为非裔美国人；平均年龄29岁；42%为女性；7%为MSM；2.5%感染HIV）。任何生殖器外GC和CT的患病率估计如下：女性中GC为2.4%，CT为3.7%；异性性行为男性中GC为2.6%，CT为1.6%；MSM中GC为18.9%，CT为11.8%。在女性中，仅进行泌尿生殖道检测会漏诊30.3%的GC感染和13.8%的CT感染。与MSM不同，年龄≤18岁是女性生殖器外感染的最强预测因素。
虽然MSM中生殖器外淋病和衣原体感染的患病率最高，但仅进行生殖器检测会漏诊大量年轻女性的GC和CT感染。需要进行成本效益分析，以帮助制定关于年轻女性生殖器外筛查的国家指南。
