August 7, 2025

Chlamydia and Gonorrhea Infections in Genital and Extragenital Samples among Men and Women

KAKristal J. AaronUniversity of Alabama at Birmingham CGCharlotte A. GaydosJohns Hopkins University EHEdward W. HookUniversity of Alabama at Birmingham

Key Points

Among 343 gay and bisexual men, 12.2% had chlamydia infections, with over 70% undetected if only genital screening was used.
In 96 men who have sex with women, 10.4% had chlamydia, all identified in genital samples without extragenital infections.
Among 329 cisgender women, 10.6% had chlamydia, and 25.7% would have been missed without extragenital testing.
The study confirms the necessity of extragenital screening for better infection detection across diverse populations.

Abstract

Abstract Background For people who have anal and/or oral sex, many programs recommend genital and extragenital (defined here as anorectal and oropharyngeal) screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) to identify all potential sites of infection. Methods We assessed genital and extragenital CT and NG prevalence among people reporting extragenital sexual exposure. Results Among 343 gay and bisexual men who reported sex with men (GBMSM), 42 (12.2%) had CT with positivity of 3.5%, 9.3% and 1.8% in the genital, anal, and oral samples, respectively. In this same group, 55 (16.0%) had NG with positivity of 5.2%, 8.5%, and 7.6% in the genital, anal, and oral samples, respectively. If only genital screening had been performed, 71.4% of CT infections and 67.3% of NG infections in GBMSM would have gone undetected. Among 96 men who only have sex with women (MSW), 10 (10.4%) had chlamydial infection—all detected in genital samples with no extragenital infections detected. Nine gonococcal infections (9.4%) were detected in MSW, with positivity of 6.3%, 2.1%, and 3.1% in the genital, anal, and oral samples, respectively. If only genital testing had been performed, no CT infections would have been missed among MSW; however, 33.3% of NG infections would have been missed. Among 329 cisgender women, 35 (10.6%) had CT with positivity of 7.9%, 6.1%, and 1.8% in the genital, anal, and oral samples, respectively. In the same group, 17 (5.2%) had NG with positivity of 4.0%, 2.1%, and 2.4% in the genital, anal, and oral samples, respectively. Among these women, 25.7% and 23.5% of CT and NG infections, respectively, would not have been detected. Conclusions The increased case finding when including extragenital testing for GBMSM and women was confirmed in this analysis. However, the benefit-cost ratio and the clinical or public health value of extragenital screening in these different populations requires further study.

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