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Open Access Research article

Evaluation of sexual history-based screening of anatomic sites for chlamydia trachomatis and neisseria gonorrhoeae infection in men having sex with men in routine practice

Remco PH Peters12*, Stephan P Verweij3, Noëmi Nijsten1, Sander Ouburg3, Johan Mutsaers4, Casper L Jansen4, A Petra van Leeuwen5 and Servaas A Morré3

Author Affiliations

1 The Hague Municipal Health Services, STI clinic, The Hague, The Netherlands

2 ANOVA Health Institute, Khutšo Kurhula Offices, Tzaneen, South Africa

3 Laboratory of Immunogenetics, Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands

4 Department of Medical Microbiology, MCH Westeinde Hospital, The Hague, The Netherlands

5 Cluster of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands

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BMC Infectious Diseases 2011, 11:203  doi:10.1186/1471-2334-11-203

Published: 26 July 2011

Abstract

Background

Sexually transmitted infection (STI) screening programmes are implemented in many countries to decrease burden of STI and to improve sexual health. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae has a prominent role in these protocols. Most of the screening programmes concerning men having sex with men (MSM) are based on opportunistic urethral testing. In The Netherlands, a history-based approach is used. The aim of this study is to evaluate the protocol of screening anatomic sites for C. trachomatis and N. gonorrhoeae infection based on sexual history in MSM in routine practice in The Netherlands.

Methods

All MSM visiting the clinic for STI in The Hague are routinely asked about their sexual practice during consulting. As per protocol, tests for urogenital, oropharyngeal and anorectal infection are obtained based on reported site(s) of sexual contact. All consultations are entered into a database as part of the national STI monitoring system. Data of an 18 months period were retrieved from this database and analysed.

Results

A total of 1455 consultations in MSM were registered during the study period. The prevalence of C. trachomatis and N. gonorrhoeae per anatomic site was: urethral infection 4.0% respectively and 2.8%, oropharynx 1.5% and 4.2%, and anorectum 8.2% and 6.0%. The majority of chlamydia cases (72%) involved a single anatomic site, which was especially manifest for anorectal infections (79%), while 42% of gonorrhoea cases were single site. Twenty-six percent of MSM with anorectal chlamydia and 17% with anorectal gonorrhoea reported symptoms of proctitis; none of the oropharyngeal infections were symptomatic. Most cases of anorectal infection (83%) and oropharyngeal infection (100%) would have remained undiagnosed with a symptom-based protocol.

Conclusions

The current strategy of sexual-history based screening of multiple anatomic sites for chlamydia and gonorrhoea in MSM is a useful and valid guideline which is to be preferred over a symptom-based screening protocol.

Keywords:
Chlamydia trachomatis; Neisseria gonorrhoeae; anorectal; oropharyngeal; screening