Triple site sexually transmitted infection testing as a crucial component of surveillance for men who have sex with men: A prospective cohort study

Roy Zucker, Michael Gaisa, Keith Sigel, Ilan Singer, Amos Adler, Dan Turner, Ronen Ben Ami, Israel Nissan, Courtney Chan, Tamar Halperin

Research output: Contribution to journalArticlepeer-review

Abstract

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are common among men who have sex with men (MSM). Many oropharyngeal and anorectal infections remain asymptomatic. We aimed to evaluate triple-site screening following PrEP introduction. We enrolled a prospective cohort study including 210 asymptomatic MSM during 2019–2020, analyzed by groups: HIV positive (HIV+), HIV−uninfected using PrEP (HIV−/PrEP+), or HIV-uninfected not using PrEP (HIV−/PrEP−). A self-administered questionnaire captured demographic information and sexual risk-taking behaviors. CT/NG testing results were compared between study groups and predictors of infection were evaluated. We included 59 HIV+, 70 HIV−/PrEP+, and 81 HIV−/PrEP− subjects. 30% (n = 62) of participants tested positive for CT/NG. HIV−/PrEP+ group had highest proportion of infections (n = 33, 47%) followed by HIV−/PrEP− (n = 16, 22%) and HIV+ (n=13, 20%; p <.001). Importantly, 98% (80/82) of pharyngeal/anorectal CT/NG infections were missed in genitourinary tract screening alone. PrEP use and previous syphilis infection were the strongest risk factor for CT/NG. Extra-genital asymptomatic CT/NG infections were prevalent among MSM. These data highlight the importance of routine extra-genital CT/NG testing in asymptomatic sexually active MSM. The study describes the consequences for three-site testing lack of implementation in the PrEP era.

Original languageEnglish
Pages (from-to)114-122
Number of pages9
JournalInternational Journal of STD and AIDS
Volume33
Issue number2
DOIs
StatePublished - Feb 2022

Keywords

  • Gonorrhea
  • chlamydia
  • epidemiology
  • men
  • screening

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