Sentinel surveillance for pharyngeal chlamydia and gonorrhea among men who have sex with men--San Francisco, 2010.
ABSTRACT Although a potentially important route for transmission, limited data exist on the burden of pharyngeal chlamydia (CT) and gonorrhea (GC) among men who have sex with men (MSM). We examined pharyngeal CT and GC among MSM screened in San Francisco in 2010.
MSM seeking services in a variety of clinical settings provided clinician-collected pharyngeal specimens that were tested using the APTIMA Combo 2 platform. The prevalence of pharyngeal CT and GC was estimated at 5 sentinel sites: the municipal STD clinic, a gay men's health clinic, an HIV care clinic, an HIV testing site, and primary care clinics supported by the San Francisco Department of Public Health. Positivity for each infection was calculated as the number of positive tests divided by the number of testers with corresponding confidence intervals (CI).
In 2010, a total of 12,454 pharyngeal CT specimens and 12,457 pharyngeal GC specimens were tested for an overall CT positivity of 1.69% (95% CI: 1.47-1.93) and GC positivity of 5.76% (95% CI: 5.36-6.19). At the 5 sentinel sites, pharyngeal CT positivity ranged from 1.10% (HIV testing site) to 2.28% (STD clinic); pharyngeal GC positivity ranged from 3.4% (HIV testing site) to 7.01% (STD clinic).
Sentinel surveillance data indicate that there is a substantial burden of pharyngeal CT and GC infections among MSM in San Francisco. Identification and treatment of pharyngeal infections could prevent ongoing transmission of these bacteria. Increasing access to nucleic acid amplification tests-based pharyngeal screening should be a public health priority.
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ABSTRACT: Ciprofloxacin resistance (CipR) among gonococcal strains in San Francisco (SF) increased between 2001 and 2006 and decreased between 2007 and 2009. Molecular typing of isolates obtained from 2005 to 2009 was performed to elucidate changes in CipR prevalence. A total of 2526 samples were collected at the SF City Clinic between 2001 and 2009. Minimum inhibitory concentrations to ciprofloxacin were obtained by agar dilution. Prevalences of CipR strains were determined, with corresponding confidence intervals (CIs). Between 2005 and 2009, 460 isolates were selected for molecular typing using Neisseria gonorrhoeae multiantigen sequence typing. Between 2001 and 2006, the prevalence of CipR increased from 3.4% (95% CI, 1.3%-5.4%) to 44% (95% CI, 39%-50%). However, in 2007 prevalence began to decrease, reaching 9.6% (95% CI, 6.0%-13%) by 2009. Of the 203 strain types identified between 2005 and 2009, 126 genogroups of closely related strain types were formed (varying by ≤1% at both target loci). Levels of CipR within the data set correlate with the prevalence of 3 major genogroups (G): G437, G1407, and G3112. Molecular typing reveals that CipR within the tested population is maintained by strain turnover between resistant genogroups. Despite early recommendation in 2002 to stop ciprofloxacin use in California, CipR in SF increased through 2006. The subsequent decrease in CipR corresponds with the 2007 national recommendation to cease ciprofloxacin treatment of gonorrhea, which suggests that national recommendations are potentially more effective at reducing CipR than regional recommendations in areas with high strain turnover.Sex Transm Dis 02/2015; 42(2):57-63. DOI:10.1097/OLQ.0000000000000233 · 2.75 Impact Factor
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ABSTRACT: Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009-May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20 min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.Sexual Health 04/2014; 11(3). DOI:10.1071/SH14003 · 1.58 Impact Factor
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ABSTRACT: To determine the prevalence of pharyngeal and rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) in Germany and describe associations between these infections, sexual practices and other factors to provide an evidence base for screening recommendations. We conducted a cross-sectional study in 22 sentinel sites of sexually transmitted infections across Germany. Pharyngeal and rectal swabs were collected and tested for CT and NG with a nucleic acid amplification test (NAAT). Information on HIV status, number of sex partners and sexual practices was collected and linked to NAAT results. Overall, 2247 MSM were screened for pharyngeal or rectal CT and NG infections; median age was 34 years (range 16-83). Prevalence of CT was 1.5% in pharyngeal and 8.0% in rectal specimens. Prevalence of NG was 5.5% in pharyngeal and 4.6% in rectal specimens. Local symptoms were reported in 5.1% of pharyngeal and 11.9% of rectal infections. Altogether 90.8% of rectal or pharyngeal infections would remain undetected if only symptomatic cases were tested. Rectal infection was significantly more likely in men reporting multiple partners (2-5 partners, OR=1.85; 6-10 partners, OR=2.10; >11 partners, OR=2.95), men diagnosed with HIV (OR=1.60) and men practising receptive anal intercourse without a condom (OR=1.54). Pharyngeal infection was more likely in men reporting multiple partners (6-10 partners, OR=2.88; >11 partners, OR=4.96), and men diagnosed with HIV (OR=1.78). Pharyngeal and rectal infections in sexually active MSM can remain undetected and thus transmissible if swabbing is not offered routinely. Screening should be offered particularly to MSM diagnosed with HIV and MSM reporting multiple partners.Sexually transmitted infections 08/2013; 90(1). DOI:10.1136/sextrans-2012-050929 · 3.08 Impact Factor