Danby Claire S, Cosentino Lisa A, Rabe Lorna K, Priest Carol L, Damare Khrystine C, Macio Ingrid S, Meyn Leslie A, Wiesenfeld Harold C, Hillier Sharon L
From the *University of Pittsburgh, Pittsburgh, PA; and †Magee-Womens Research Institute, Pittsburgh, PA.
Sex Transm Dis. 2016 Feb;43(2):105-9. doi: 10.1097/OLQ.0000000000000384.
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.
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).
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.
Reliance on urogenital screening alone misses most of GC and CT in men and more than 15% of infections in women reporting RAI.
对男男性行为者进行沙眼衣原体（CT）和淋病奈瑟菌（GC）筛查是基于风险的。尽管女性中口交和接受肛交（RAI）的频率很高，但不建议进行生殖器外筛查。
主要从一家性传播感染诊所招募的有RAI终生史的女性（n = 175）和男男性行为者（n = 224）完成了一份结构化问卷，并由临床医生从直肠、咽部、阴道（女性）和尿液（男性）采集拭子样本。使用两种商业核酸扩增检测方法（Aptima Combo 2；Hologic公司，贝德福德，马萨诸塞州；Xpert CT/NG，Cepheid Innovation公司，森尼韦尔，加利福尼亚州）检测CT和GC。
研究人群的中位年龄为26岁，62%为白人，88%来自性传播疾病诊所。男性感染GC（22.8%对3.4%）和CT（21.9%对12.6%）的可能性高于女性。与女性相比，男性咽部拭子中GC的检出率为16.5%对2.3%，直肠拭子中为11.6%对2.3%，尿液样本或阴道拭子中为5.4%对2.9%。男性咽部拭子中沙眼衣原体的检出率为2.2%对1.7%，直肠拭子中为17.4%对11.4%，泌尿生殖部位为4.5%对10.3%。总体而言，男性中79.6%的CT和76.5%的GC以及女性中18.2%的CT和16.7%的GC仅在咽部或直肠中被检测到。
仅依靠泌尿生殖器筛查会遗漏男性中大部分的GC和CT以及报告有RAI的女性中超过15%的感染。
