MISSED OPPORTUNITIES OF CHLAMYDIA AND GONORRHEA DETECTION WHEN NOT USING EXTRA GENITAL SCREENING AMONG MALES

Abstract

BackgroundThrough extra genital screening methods, Health Departments and community clinics can increase detection of sexually transmitted diseases (STDs) through the application of urethral testing. The Long Beach Department of Health and Human Services (LBDHHS) works on preventing cases of chlamydia (CT) and gonorrhea (GC) from being undiagnosed, by providing extra genital screening. MethodsRetrospective medical review of 1,571 patient health records, who received CT/GC testing, based on at least 1-visit to the Long Beach Department of Health & Human Services, STD Clinic, between 2012 to 2015. All male patients ages 18 years or older with positive CT/GC results (242 cases) for any of the three sites (e.g. urethral, rectal, and pharyngeal); regardless of their sexual behaviors, were included in the study. Females, those under the age of 18, and patients who tested negative for all three anatomical sites were excluded (1,412 controls). ResultsAt time of collection, study participants had a mean age of 37 years. Reported ethnicity indicated 56% Caucasian, 21% Hispanic or Latino, 9% Asian or Pacific Islander, 7% Other, 5% Black, and 2% More than one race. The use of extra genital screening detected 15% (242) of the 1,571 patients tested positive for at least 1-type of CT/GC infection. Our findings demonstrated that if urine was the only specimen collected, then over 29.7% of CT and 46.8% of GC cases would have been missed. ConclusionsTesting of all three anatomical sites should continue to be performed for CT/GC detection. Cases of CT/GC are underreported if performing urethral screening alone. These results highlight the need for clinicians to perform extra genital screening among male patients for prevention and control. These testing measures may reduce the potential for missing a diagnosis and mitigating transmission. Short SummaryThe number of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections missed were determined using extra genital screening procedures among male patients from the Long Beach Department of Health and Human Services (LBDHHS), STD/Family Planning Clinic. This method tests urethral, pharyngeal, and rectal sites for CT and GC infection. In this retrospective review of 1,571 patient files, of which 242 tested positive, we determined the proportion of cases that would have remained undetected if only using urethral screening.