Extragenital screening for chlamydia and gonorrhea increases prevalence of infection in women reporting to Chicago Department of Public Health STD clinics

Background:

Chlamydia (CT) and gonorrhea (GC) are the most common reportable sexually transmitted diseases (STDs), but the burden of extragenital infection in women is not well characterized. Our objective was to describe CT and GC infection among women seen at Chicago public health STD specialty clinics.

Methods:

We retrospectively reviewed medical records of women seen at five clinics between April 2014 and September 2014. Extragenital screening was performed only for women reporting exposure at a given anatomical site in the last three months. Only women tested extragenitally were included in our analysis.

Results:

Among 1042 women, 12.1% (126) were non-Hispanic white, 62.5% (651) non-Hispanic black, 19.4% Hispanic (202), and 6.0 % (63) other/unknown. The median age was 26.

Out of a total of 2291 tests performed, 1077 were urogenital, 1091 oropharyngeal, and 123 rectal. Data were further stratified by anatomical site positivity rate for both diseases. For CT, 12.6% (135) of urogenital, 3.1% (34) of oropharyngeal, and 13.1% (16) of rectal tests were positive. For GC at these sites, respectively, 3.9% (42), 2.8% (30), and 3.3% (4) of tests were positive.

For those with both urogenital and extragenital results, urogenital-only testing would have missed 18.2% and 31.3% of oropharyngeal and rectal CT infections, respectively, and 34.5% and 25.0% of GC infections.

Conclusions:

High chlamydia and gonorrhea positivity from extragenital sites highlights the need for further research studies in order to better evaluate the need for national extragenital screening recommendations for CT and GC in women.