STD screening strategies: Urine not enough in MSM

Published: June 14, 2013

WASHINGTON – Screening for chlamydia and gonorrhea infections using urine testing alone would have missed more than three-fourths of infections in a population of gay youth, a study has found.

"Urine screening alone is not a reliable proxy for all sites for gonorrhea and chlamydia infections in a youth men-who-have-sex-with-men population," reported Dr. Katie Plax at the annual meeting of the Pediatric Academic Societies (PAS).

Instead, it appears that triple screening – with pharyngeal and rectal testing done along with genital screening through urine tests – can enhance the detection of chlamydia and gonorrhea, especially in this high-risk population.

Dr. Plax and her coinvestigators screened 135 young men who have sex with men (MSM), aged 14-24 years, during 189 visits to a drop-in youth center in St. Louis that provides health and social services. Each of the youth had triple screening with nucleic acid simplification testing of urine, rectum, and pharyngeal specimens.

Of all the positive test results over the 12-month study, only 17% were from urine specimens, whereas 82% were in rectal or throat specimens. (There were 29 positive chlamydia tests in 26 of the 135 men, and 72 positive gonorrhea tests in 51 of the men. Twelve of the young men were positive for both infections.)

Urine screening alone would have missed 85% of chlamydia infections and 72% of gonorrhea infections, their analysis shows, while throat screening alone would have missed 88% of chlamydia infections and 43% of gonorrhea infections. Rectal screening had the highest yield, with the estimated rates of missed infections being 15% and 41%, respectively.

"More attention should be focused on the role that extragenital infections play," said Dr. Plax, director of the Adolescent Center at St. Louis Children’s Hospital and associate professor of pediatrics at Washington University in St. Louis. "For HIV-uninfected patients, this is a public health emergency, because we know that an STD [sexually transmitted disease] diagnosis is both a marker for potentially high-risk activity and also a potential cofactor for HIV acquisition."

Gonorrhea infections in particular "have been identified as one of the strongest and most consistent risk factors associated with HIV seroprevalence and HIV seroconversion," she said.

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