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OBJECTIVES: Chlamydia and gonorrhoea have remained the most common nationally notifiable sexually transmitted infections (STIs) in the USA, demonstrating a need for more clarity on rates of testing and diagnosis. Behavioural changes (eg, declining condom use) may contribute to high cases, although sexual activity rates have decreased. Increased STI screening, especially among women, could also influence diagnosis rates. Research shows differences in infection rates by anatomical site (urogenital, oral, rectal) and the need for more comprehensive screening. This study aimed to explore how screening and diagnosis differ across sites in populations with exclusively opposite-sex sex partners. METHODS: This rapid review assessed the current landscape of screening and diagnosis of chlamydia and gonorrhoea in populations with opposite-sex sex partners, focusing on comparisons across anatomical sites. CENTRAL, PubMed and Embase were searched, and a risk of bias assessment was conducted to qualitatively examine potential bias across studies. RESULTS: A total of 25 studies from 2010 to 2023 were reviewed, focusing on chlamydia and gonorrhoea screening and diagnosis across urogenital, rectal and pharyngeal sites. Urogenital screening was most common, while pharyngeal screening was least common. Diagnosis rates varied. Median test positivity was 8.8% (women) and 2.1% (men) for rectal chlamydia, 2.9% (women) and 4.1% (men) for rectal gonorrhoea, 2.3% (women) and 1.1% (men) for pharyngeal chlamydia, and 2.6% (women) and 2.4% (men) for pharyngeal gonorrhoea. Women were more frequently screened for extragenital sites, rectal and pharyngeal diagnoses were more common in women, and urogenital diagnoses were slightly more common in men. Most studies found co-occurrence of infection at multiple sites or extragenital infection without urogenital infection. CONCLUSION: This review highlights the current understanding of screening and diagnosis of chlamydia and gonorrhoea among populations with exclusively opposite-sex sex partners and supports the need for increased screening, particularly of extragenital sites, to reduce transmission rates.
Lawley et al. (Fri,) studied this question.