From the Johns Hopkins School of Medicine.
Baltimore City Health Department, Sexual Health and Wellness Clinics, Baltimore, MD.
Sex Transm Dis. 2023 Mar 1;50(3):138-143. doi: 10.1097/OLQ.0000000000001743. Epub 2022 Dec 13.
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.
2021 年美国疾病控制与预防中心性传播感染治疗指南建议，对男男性行为者和有报告性行为和暴露史的女性进行生殖道外淋病和衣原体检测。“IWantTheKit（IWTK）”项目是一个免费的在线标本采集和邮寄平台，用于联合进行衣原体/淋病检测。我们旨在评估与仅进行生殖道检测相比，生殖道外检测对衣原体/淋病的额外诊断价值，并确定 IWTK 用户中生殖道外检测阳性结果的相关因素。
2013 年 8 月至 2022 年 1 月，7612 名独特的 IWTK 用户返回了用于检测的拭子；3407 名（45%）用户同时要求进行生殖道外和生殖道检测，并纳入本分析。对人口统计学特征、报告的行为以及生殖道外和生殖道检测结果进行了描述性统计，并按性别和年龄组进行了分层。使用逻辑回归模型估计了因素与生殖道外性传播感染阳性之间的关联。
生殖道衣原体阳性率分别为 4.7%、2.4%和 1.5%；生殖道外、生殖道和两者均为阳性的淋病阳性率分别为 0.4%、1.1%和 0.4%。在女性中，年龄在 25 岁及以下与生殖道外衣原体显著相关（比值比 [OR]，4.0；P = 0.010）。处于高风险测试分数组与生殖道外衣原体（OR，2.6；P = 0.005）和男女性生殖道外淋病（OR，8.5；P = 0.005）相关。
IWTK 用户人群中，生殖道外检测发现了额外的衣原体和淋病病例，如果仅进行生殖道检测，这些病例可能会被遗漏，尤其是对于年龄在 25 岁以下和报告有高风险的人群。
