Characteristics associated with urine and rectal STI diagnoses in a U.S. representative sample of gay and bisexual men: Results from the One Thousand Strong panel

BACKGROUND. Gay and bisexual men (GBM) are at elevated risk for gonorrhea and chlamydia trachomatis (GC/CT). Rectal GC/CT symptoms may be less obvious than urethral and require more invasive testing procedures (anal swab vs. urine)—increasing opportunities for undiagnosed rectal GC/CT.

METHOD. A nationally representative sample of 1,071 GBM completed urethral and rectal GC/CT testing and an online survey.

RESULTS. In total, 6.2% were GC/CT positive (5.3% rectal, 1.7% urethral). Men diagnosed with GC/CT (urethral, p<.01; rectal, p<.001) were significantly younger. Single men had 1.8 higher odds than men in relationships of being diagnosed with rectal (p=.034), but not urethral (p=.914), GC/CT. Race/ethnicity was associated with rectal GC/CT (p=.046)—men of color being at greater risk for diagnosis—but not urethral (p=.924). Having health insurance (p=.229, p=.406) and a primary care provider (p=.290, p=.136) were not associated with rectal or urethral GC/CT; however, rectal (p=.028) and urethral (p=.029) diagnoses were associated with lower income.  Reporting a greater number of anal receptive acts and receptive condomless anal sex (CAS) acts were associated with both rectal (p<.001, p<.001) and urethral (p=.010, p=.006) GC/CT diagnosis. Reporting a greater number of anal insertive (p=.050) and insertive CAS acts (p=.003) were associated only with rectal GC/CT diagnosis.

CONCLUSION. Rectal GC/CT was more common than urethral and associated with several demographic and behavioral characteristics. Our finding that insertive CAS acts was associated with rectal GC/CT highlights the importance for providers to screen patients for GC/CT via a full range of transmission routes, lest GC/CT go undiagnosed.