199505 Rectal Chlamydia testing among MSM attending an STD clinic

Monday, November 9, 2009: 1:35 PM

Lenore Asbel, MD , Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA
Greta L. Anschuetz, MPH , Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA
Felicia Lewis, MD , Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA
Melinda Salmon , Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA
CDC recommends testing Men who have Sex with Men (MSM) at all exposure sites. A study at City Clinic in San Francisco found high prevalence of Chlamydia (CT) and Gonorrhea (GC) rectal infections among MSM using a nucleic acid amplification test (NAAT). Following internal validation by our Public Health Lab a protocol for testing at all exposure sites using APTIMA combo 2 was implemented in Philadelphia Department of Public Health STD clinics.

Prior to implementing NAAT testing at rectal site for GC/CT, rectal cultures were routinely performed for GC but no testing for Chlamydia was available. We sought to determine the prevalence of rectal Chlamydia trachomatis infections among MSM and the number of patients who would not have received treatment under the previous testing protocol.

Data were extracted from our medical record system to include MSM who had a rectal NAAT ordered. Other test results completed on other exposure sites were included.

Preliminary results from the first months of implementation show that 177 MSM patients were seen, 74 (41.8%) were tested for rectal Chlamydia. Fourteen (18.9%) positive rectal Chlamydia tests were diagnosed. Seven of the 14 would have received empirical treatment for Chlamydia based on a positive rectal NAAT result for gonorrhea (N=6) or a diagnosis of NGU (N=1).

Without NAAT rectal testing, our STD clinic would have missed treating 7cases of Chlamydia among MSM. This analysis provides further supporting evidence that NAAT testing needs to be routine for higher risk populations.

Learning Objectives:
1. Describe rectal Chlamydia prevalence among MSM seen in an STD clinic. 2. Assess the importance of testing multiple exposure sites for MSM.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: EDUCATION: July 1987 - May 1991 Doctor of Medicine Medical College of Pennsylvania (now Drexel University College of Medicine) Philadelphia, PA 19129 September 1984 - May 1987 Bryn Mawr College Bryn Mawr, PA 19010 Major: Biology Thesis: Central Nervous System Regeneration POST DOCTORAL TRAINING July 1991 - June 1994 Internship and Residency in Internal Medicine Medical College of Pennsylvania Hospital Philadelphia, PA 19129 July 1994 - June 1995 Chief Resident in Internal Medicine Medical College Hospitals Elkins Park Elkins Park, PA 19118 July 1995 - June 1997 Fellow in Infectious Diseases Allegheny University of the Health Sciences (now MCP Hahnemann University) Philadelphia, PA 19129 EMPLOYMENT HISTORY July 1997 present MCP Hahnemann University School of Medicine Division of Infectious Diseases Assistant Professor of Medicine Medical Director of City of Philadelphia District Health Center 1 (Sexually Transmitted Diseases Clinic) Medical Specialist STD Programs City of Philadelphia CERTIFICATION AND LICENSURE: Diplomate American Board of Internal Medicine 1994 Diplomate American Board of Internal Medicine in Infectious Diseases 1998 Medical License: Commonwealth of Pennsylvania since 1991
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.