pharyngeal gonorrhea and chlamydia infections in msm in

pharyngeal gonorrhea and chlamydia infections in msm in

Poster 972
PHARYNGEAL GONORRHEA AND CHLAMYDIA INFECTIONS IN MSM IN A MULTI ETHNIC STD CLINIC Renee Jiddou MD1, Maria Alcaide MD2, Isabella Rosa-Cunha MD2, Jose Castro MD2
1University
Background
• Pharyngeal infections with gonorrhea (GC) and chlamydia
(CT) can be missed if screened only by routine methods of
urethral, urine or rectal specimens.
• The prevalence of pharyngeal GC/CT in Men who have Sex
with Men (MSM) has been reported as 5.3-9.2% and
1.4-1.9% respectively.
• No data on pharyngeal GC/CT infections is available in
Miami, a multiethnic city where rates of STI in the MSM
population are very high.
of Miami/Jackson Memorial Hospital, Miami, FL, USA , 2Division of Infectious Diseases, University of Miami
Miller School of Medicine , Miami, FL, USA Figure 1. Results of gonorrhea (GC) and chlamydia (CT) tesKng in MSM 499 paJents had pharyngeal swabs performed between October 2011 and March 2012 Results
52/499 (10.4%)
paJents had pharyngeal NAAT posiJve for GC 40/52 (77%) had rectal NAAT performed 21/40 (52.5%) paJents had rectal NAAT posiJve for GC 50/52 (96%) had urine NAAT performed 14/50 (28%) paJents had urine NAAT posiJve for GC 18/52 (35%) had urethral cultures for GC Objectives
• To determine the rates of pharyngeal GC and CT infection in
MSM in the Miami Dade County Health Department
(MDCHD) STD clinic.
Methods
• Routine pharyngeal GC/CT testing in MSM was
implemented in the Miami Dade County Health Department
STD clinic in October 2011.
Assay®
• APTIMA Combo 2
was used for testing and
validation studies were performed in the Florida Department
of Health Laboratories prior to implementation of the test.
• Retrospective review of medical records of individuals tested
for pharyngeal GC/CT from October 2011 to March 2012 was
performed.
• Demographic data, history of other STIs, concurrent STIs,
HIV results, and results from urine and rectal NAAT testing
were also reviewed.
• University of Miami and Florida Department of Health IRB
approval was obtained prior to any study related activities.
Table 1, Table 2. Demographics and risk factors in MSM with posiKve GC and/or CT pharyngeal NAAT (number of paKents =62) 13/499 (2.6%) paJents had pharyngeal swabs posiJve for CT 10/13 (77%) had rectal NAAT performed 13/13 (100%) had urine NAAT performed Table 1 29.2 years old Race 50 (81%) White, 12 (19%) Black Ethnicity 44 (71%) Hispanic 18 (29%) Non-­‐Hispanic 52 (84%) sex with men only 10 (16%) sex with men and women # Partners 2 months (mean, range) 3.55 (0-­‐100) # Partners in 12 months (mean, range) 7.94 (1-­‐100) # New Sex Partners 2 months (mean) 3/10 (30%) paJents had rectal NAAT posiJve for CT 21/40 PosiJve 14/50 PosiJve Figure 3. PaKents with posiKve pharyngeal chlamydia NAAT checked for rectal NAAT (green) and urine NAAT (orange) 3/10 PosiJve 1/13 PosiJve 1/13 (7.7%) paJents had urine NAAT posiJve for CT Conclusions
• The prevalence of pharyngeal GC/CT in MSM in
the MDCHD STD clinic is higher than that
previously reported at other centers.
• The heterogeneity between pharyngeal, rectal,
and urine tests emphasizes the importance of
extragenital testing in the MSM population.
• Prevalence of HIV infection in individuals with GC/
CT infection is high, reinforcing the need for
extragenital screening by HIV providers. Limitations
•  Our study only includes subjects that seek care
at the Department of Heath and the population
may not be fully inclusive of all the age groups
affected with STIs.
• Retrospective review may not reflect accurate
sexual history and risk factors.
Table 2 Age Sexual orientaJon 14/18 (78%) had posiJve cultures Figure 2. PaKents with posiKve pharyngeal gonorrhea NAAT checked for rectal NAAT (green) and urine NAAT (orange) 2.82 (0-­‐99) Condom Use (last encounter) 24 (39%) Yes 38 (61%) No Urethral/Rectal Discharge 18 (29%) Yes 44 (71%) No History of STD 34 (55%) Yes, 28 (45%) No Prior HIV Status 15 (24%) PosiJve, 41 (66%) NegaJve, 5 (8%) Unknown, 1 (2%) Indeterminate HIV Diagnosis on this Visit 6 (10%) PosiJve, 31 (50%) NegaJve, 25 (40%) Not Checked Acknowledgments
Miami Dade Health Department personnel and clinic staff.
References
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Infections Missed by Urethral-Only Screening for Chlamydia or
Gonorrhea Detection Among MenWho Have Sex With Men. Sexually
Transmitted Diseases. (2011) 38 (10): 922-924.
Prevalence of Rectal, Urethral, and Pharyngeal Chlamydia and
Gonorrhea Detecte in 2 Clinical Settings among Men Who Have Sex
with Men: San Francisco, California, 2003. Clin Infect Dis. (2005) 41 (1):
67-74.
http://www.cdc.gov/std/gonorrhea/STDFact-gonorrhea.htm
http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm
htts://www.cdc.gov/std/hiv/STDFact-HIV.htm
http://www.cdc.gov/std/treatment/2010/specialpops.htm
http://www.cdc.gov/std/stats07/msm.htm