2) CDC. - Microbicide Trials Network



Patterns of Extragenital Chlamydia and Gonorrhea in Men and Women Reporting a History of Receptive Anal IntercourseClaire S Danby, MD1, Lisa A Cosentino, MS2, Lorna K Rabe, BS2, Carol L Priest CRNP2, Khrystine C Damare BS2, Ingrid S Macio, PA2, Leslie A Meyn, PhD2, Harold C Wiesenfeld, MDCM1, Sharon L Hillier, PhD1,21University of Pittsburgh and the 2Magee-Womens Research Institute, Pittsburgh, PA, USACorresponding Author:Claire Danby, MDMaine Medical Partners – Women’s Health887 Congress St. Portland, ME 04102E-mail: danbycs@upmc.eduPhone: 207-771-5549Fax: 207-771-7834Address for Reprints: No reprints are availableWord Counts:Summary: 29Abstract: 250Text: 2693Figures: 4Tables: 3Conflicts of interest: NoneSources of support: Cepheid donated the collection and test kits for Neisseria gonorrhoeae and Chlamydia trachomatis. The Microbicide Trials Network is funded by the National Institute of Allergy and Infectious Diseases (UM1AI068633 and 5UM1AI106707), with cofunding from the National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health. Short Summary: Among people reporting a lifetime history of anal receptive intercourse, sexually transmitted infections are detected only at extragenital sites in up to 80% of men and 17% of women.Abstract: Background:Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in men who have sex with men (MSM) is risk-based. Despite the high frequency of oral and anal intercourse (AI) among women, there are no recommendations for extragenital screening.Methods:Women (n=175) and MSM (n=224) reporting a lifetime history of AI completed a structured questionnaire and clinicians collected swab samples from the anorectum, pharynx, vagina (women) and urine (men). CT and GC were detected using two commercial nucleic acid amplified tests (Aptima Combo 2, Hologic, Inc; Xpert CT/NG, Cepheid Innovation).Results: The median age of the population was 26, 62% were Caucasian, and 88% were enrolled from an STD clinic. Men were more likely than women to have GC (22.8% vs 3.4%, p <0.001) and CT (21.9% vs 12.0%, p=0.01). In men vs women, GC was detected in 16.5% vs 2.3% (p <0.001) of pharyngeal swabs, 11.6% vs 2.3% (p <0.001) of rectal swabs and 5.4% vs 2.9% of urine samples or vaginal swabs. Rectal swabs were positive for CT in 17.4% vs 10.9% of men vs women, pharyngeal swabs were positive in 2.2% vs 1.7%, and 4.5% vs 10.3% for urogenital sites (p =0.03). Overall 79.6% of CT and 76.5% of GC in men and 14.3% of CT and 16.7% of GC in women were detected only in the pharynx or anorectum. Conclusion: Reliance on urogenital screening alone misses the majority of GC and CT in men and a more than 10% of infections in women reporting AI. Introduction: Chlamydia trachomatis and Neisseria gonorrhoeae are the two most common bacterial sexually transmitted infections (STIs) in the United States.1 Despite the availability of sensitive tests, broad scale screening in young women, and effective treatment, the prevalence of C. trachomatis has increased over the past decade.2 While the Centers for Disease Control and Prevention (CDC) recommends annual genitourinary testing for all sexually active women age 25 and under, their most recent nationally representative study estimates found that only 38% of sexually active women ages 15 to 25 were tested for urogenital chlamydia during the previous year. 3 Screening efforts have focused primarily on genitourinary screening and there are no recommendations for routine extragenital screening. The frequency of oral and receptive anal intercourse (AI) is increasing among young heterosexual adults,4 and receptive AI among women is a common sexual practice.5, 6, 7 Nationally reported samples have revealed that 36 to 40% of women aged 20 to 49 reported ever having AI.8, 9 Women report infrequent use of condoms during receptive AI, 10 in some studies as low as 16%.11For men the recommended schedule for STI testing is based on risk and sexual activity: heterosexual males are to be offered testing in settings where prevalence is high, while the CDC recommends annual gonorrhea and chlamydia screening for men who have sex with men (MSM) based on risk. Testing of urine is recommended for those who report insertive intercourse in the preceding year, while testing of anorectal swabs is recommended for those who report receptive AI. In men, testing for pharyngeal N gonorrhoeae is recommended for those who report receptive oral sex, regardless of self-reported condom use.1 Despite numerous publications outlining the rising prevalence of rectal gonorrhea and chlamydia, extragenital screening for these STIs is not always performed when indicated. 12 Extragenital N. gonorrhoeae and C. trachomatis may be important reservoirs for ongoing disease transmission. High rates of extragenital gonorrhea and chlamydia among MSM have been well documented.13-15 Previous studies have reported that 70% of extragenital gonorrheal and 85% of extragenital chlamydial infections were documented in men having no urethral infections.16 Thus, there is growing concern that urogenital testing alone misses a large proportion of men who are positive for infection. Urogenital screening in women is reported to miss a smaller percentage of total infections compared to MSM,17 though data are limited. The objective of this study was to determine the prevalence of extragenital Chlamydia trachomatis and Neisseria gonorrhoeae in men and women using the same inclusion criteria, namely reporting a lifetime history of receptive anal intercourse. Although other studies have evaluated extragenital sexually transmitted infections in men13-15 and women6,17, none have previously included both rectal and pharyngeal testing in both men and women using two different nucleic acid amplification testing (NAAT) techniques. Materials and Methods:Study population and Design:This cross-sectional study was conducted from March 2014 to March 2015 at two centers in Pittsburgh, PA, USA: Allegheny County Health Department (ACHD) and Magee-Womens Hospital of UPMC. Recruiting staff was present at each facility to screen participants for eligibility. All participants reported a lifetime history of receptive anal intercourse. Participants were excluded if they reported use of oral antibiotics over the previous 7 days, use of rectal douche or other rectal products in the past twenty-four hours, and, if female, use of vaginal douche or vaginal product in the previous 24 hours. The study was approved by the University of Pittsburgh Institutional Review Board, Pittsburgh, PA. After written informed consent was obtained, a questionnaire was administered asking a series of questions about age, ethnicity and sexual activity history and symptoms. Specimen Collection:Study clinicians inserted two sequential swabs approximately 2.5cm above the anal margin and placed into the appropriate transport media. Pharyngeal swabs were collected from each lateral posterior wall, including tonsillar crypts, and the pharyngeal arc. For males, urine samples were obtained as first-pass collection at least 1 hour greater than last void. For women, vaginal swabs were obtained by clinicians without placement of a speculum. The two swabs collected use NAAT technology: GenProbe’s Aptima Unisex Collection Swab (Aptima, Aptima Combo 2; Hologic Inc., Bedford, MA) and the Cepheid Xpert CT/GN Assay (Xpert, Cepheid Innovation, Sunnyvale, CA). An additional swab was obtained from the pharynx for N. gonorrhoeae culture. The order of collection of the two NAAT swabs was predetermined by computer randomization, while the pharyngeal N. gonorrhoeae culture was obtained first per CDC guidelines.1 Laboratory Testing for C. trachomatis and N. gonorrhoeae:All swabs were transported to the reference laboratory within 24 hours (median 2.4 hours, range 5 minutes to 21.2 hours). Testing was conducted per package insert instructions (Aptima Combo 2 package insert IN0037-04 Rev A; Gen-Probe Inc., San Diego, CA). Xpert testing for N. gonorrhoeae and C. trachomatis was conducted per package insert instructions (GeneXpert package insert CXCT/NG-CE-10; Cepheid Innovation, Sunnyvale, CA). Xpert is Food and Drug Administration (FDA) approved for the detection of N. gonorrhoeae and C. trachomatis from genitourinary samples. Neither NAAT method has been FDA approved for detection of these pathogens from rectal or pharyngeal samples, but Aptima had been previously validated in the reference laboratory for testing of N. gonorrhoeae and C. trachomatis from rectal samples. Cultures for N. gonorrhoeae was not initially included in the study because previous studies found a very low level of sensitivity for culture from rectal swab samples.18,19 However, after an interim analysis of the first 150 participants enrolled and the high number of pharyngeal samples positive for N gonorrhoeae, culture testing of the remaining 249 pharyngeal samples was added as an additional confirmatory test. A single Dacron swab of the throat was used to inoculate two selective agar plates, designed to enhance the growth of N. gonorrhoeae (Modified Thayer-Martin agar and GC-Lect agar), and one non-selective agar (chocolate agar). The three agar plates were placed in a candle jar to reduce the oxygen and transported to the reference laboratory on the day of collection. Upon receipt in the laboratory the agar plates were transferred to a 37oC, 6% CO2 incubator. After 24 and 48 hours the plates were examined for growth. Organisms growing on either the Thayer-Martin or GC Lec that are Gram-negative diplococci and have the indophenol oxidase enzyme were confirmed using API NH (bioMerieux, Inc, Marcy-I’Etoile, France). Definition of a Positive Test Result:As both Aptima and Xpert are FDA approved test systems validated for genitourinary samples, any positive result was defined as positive for infection. For rectal and pharyngeal GC and CT swab samples, any Aptima or Xpert positive result (including a discrepant test result) was verified using the appropriate Aptima CT or Aptima GC assay, which targets different nucleic acid sequences. A pharyngeal specimen identifying N. gonorrhoeae was also defined as a true positive for infection, regardless of NAAT result. Data Analysis:Descriptive statistics including median, range and frequency distributions were performed for all demographic and risk behavior characteristics. P values were calculated using Fisher’s exact or Mann-Whitney U tests. Data analyses were conducted with SPSS statistical software, release 22.0. (IBM Corp, Armonk, NY). Venn diagrams were created using eulerAPE, version 1.0 (University of Kent, Canterbury, UK). Results: Characteristics of Study Population: A total of 399 participants were recruited: 224 men and 175 women. The median age of the men was 26 years (range 18 to 62) and 27 years (range 18 to 49) for women (Table 1). The male and female populations differed with respect to self-identified race and site of enrollment (Table 1). Men had a higher median number of male partners in the month and year compared to women (p <0.001 for each time period). Condom use with AI was reported significantly more for men at 86.6 % than for women at 37.7 % (p <0.001). AI after vaginal sex without condom change in 6 of the last 10 sexual encounters was reported in 53.7 % of women. Although the minority of individuals were African American race, African American men were more likely to test positive for C. trachomatis (p = 0.024) and African American women were more likely to test positive for N. gonorrhoeae (p = 0.015). Evaluation of swab collection order showed that there was no significant difference in test positivity by order of collection (data not shown). Symptoms Associated with Infection: Males with gonorrhea were more likely to be symptomatic at any anatomic site (p= 0.02) or have urogenital symptoms (p= 0.001) when compared to men without sexually transmitted infections (Table 2). Men with C. trachomatis were not more likely to have symptoms at any site than those who tested negative for sexually transmitted infections. Women who had pharyngeal N. gonorrhoeae or C. trachomatis were more likely to have pharyngeal symptoms than uninfected women (p= 0.003 and 0.01, respectively). Genital infection was not related to urogenital symptoms in women (Table 2). Infections by Site: Overall, 22.8% of men vs. 3.4% of women had N. gonorrhoeae at any site (p <0.001), and 21.9% of men vs. 12.0% of women had C. trachomatis at any site (p = 0.01, Table 3). A significantly greater percentage of men tested positive for N. gonorrhoeae from rectal swabs than women, 11.6 to 2.3% respectively (p <0.001). Similarly, a significantly greater proportion of men tested positive for N. gonorrhoeae from pharyngeal swabs than women, at 16.5 to 2.3%, respectively (p <0.001). A significantly greater percentage of women tested positive for genitourinary chlamydia than men at 10.3% compared to 4.5% (p value 0.03). Venn diagrams were created in order to visually demonstrate the patterns of sexually transmitted infections by site in order to display how many cases of extragenital gonorrhea or chlamydia would be missed if only genitourinary screening took place (Figures 1 through 4). In the 49 men positive for C. trachomatis at any site, 10 (20%) were positive in their urine, while an additional 39 (80%) were positive only at extragenital sites (34 rectally, 2 pharyngeally and 3 in both). Of the 51 men having N. gonorrhoeae at any site, only 12 (24%) were positive in the urine, while the remaining 39 (77%) were positive at only extragenital sites (17 pharyngeal, 8 rectal and 14 in both). Among women, fewer extragenital infections would be missed compared to men if urogenital samples alone were relied upon for screening. Among the 21 women who tested positive for C. trachomatis at any site, 86% were positive using the vaginal swab sample. Of these, 2 were positive in the vagina alone, 13 (62%) were positive by both vaginal and rectal swabs, and the remaining 3 women (14%) had C. trachomatis identified in swabs from all three locations. Thus, a single vaginal swab was sufficient to correctly identify 85% of women with chlamydial infection. Of the 6 women who tested positive for N. gonorrhoeae at any site, 5 (83%) were positive from the vaginal swab sample. The remaining 1 woman was positive for N. gonorrhoeae on pharyngeal swab by both NAATs. Discussion: This study adds to the growing body of evidence reporting a high prevalence of extragenital STIs among men and women who have a lifetime history of receptive AI. In MSM the overall prevalence of infection at any site was 22.8% for N. gonorrhoeae and 21.9% for C. trachomatis. In women the 3.4% rate of gonorrhea at any site was significantly less than in MSM, while the overall prevalence of chlamydia remained high at 12%. Notably, if genitourinary screening alone was relied upon for men, 80% of chlamydia and 77% of gonorrhea would be missed. The results of this study support the current CDC guidelines, which recommend site-specific risk based screening in MSM. With this study revealing even higher rates of extragenital infection with concurrent negative urinary tests, further emphasis should be placed on the need for adequate history taking and following screening guidelines in men reporting receptive AI. The population studied resembled the population demographics of other similar studies with respect to age, race, STI history and sexual practices. 6,7 In MSM, the prevalence of 11.6% for N. gonorrhoeae and 17.4% for C. trachomatis in rectal swab samples was higher than those published from an earlier study with similar inclusion criteria, where rates were 6.2 and 8.9%, respectively.18 The current study also found a higher prevalence of infection compared to various studies of MSM, where the prevalence of rectal chlamydia ranged from 4 to 9%, and rectal gonorrhea from 7 to 9%.6, 13-15 Our study showed that pharyngeal infection in MSM was 16.5% for gonorrhea and 2.2% for chlamydia, higher than previously reported by a CDC coordinated study in 2007.19 It is unclear whether the higher rates of infections observed in the present study are attributable to increased rates of infections, a higher level of ascertainment due to the use of multiple tests or both. Among women, the frequency of extragenital gonorrhea and chlamydia in the present study was comparable to previous literature.6,7,20 Currently, the CDC does not recommend a risk-based approach for screening in women as the overall benefit is unclear. Published studies suggest that if vaginal screening alone is relied upon in women, rates of missed infection ranges from 18 to 40% for gonorrhea7,20 and from 6 to 25% for chlamydia.6,7 In our study, genitourinary screening in women who reported a history of anal receptive AI missed approximately one in seven chlamydia and gonorrhea infections, which is consistent with the published literature. Our data suggests that rectal screening for sexually transmitted infected could be considered among women reporting anal intercourse. There is debate as to whether or not the rectum is truly infected in women having positive NAAT tests for sexually transmitted infections, or whether the tests are positive secondary to autoinoculation due to close proximity to vaginal secretions.21 In one study, some participants having positive rectal swab results denied any history of AI, and led the authors to conclude that no correlation exists between reported anal sex and rectal infection.22 However, it is also possible that women denied anal receptive sex due to social stigma. As with men, it is likely that an approach to extragenital screening in women should be based on risk factors. There is less debate surrounding whether the pharynx is a site that is infected by bacterial STIs. Oral sex is common in men and women, and urogenital organisms are increasingly transmitted to the pharynx. Peters et al. demonstrated that of women who tested positive for N. gonorrhoeae or C. trachomatis at any site, one third were positive in the pharynx only.17 Although there have been reports of pharyngeal infection resolving spontaneously,23 those with infection can be symptomatic and infections can be transmitted to men by fellatio, suggesting that the presence of N. gonorrhoeae or C. trachomatis reflects an important reservoir of infection. The majority of extragenital infections in our study were asymptomatic. MSM who tested positive for either N. gonorrhoeae or C. trachomatis in either the rectum or the pharynx were not significantly more symptomatic than those who tested negative. Women with pharyngeal gonorrhea or chlamydia were more likely to report pharyngeal symptoms, in comparison to those without STIs (p= 0.003 and 0.01, respectively). The reporting of symptoms in the present study is consistent with other studies, where 52-86% of MSM with rectal infections were asymptomatic14,15 and 98% of women were asymptomatic.6Neither NAAT used to identify N. gonorrhoeae nor C. trachomatis by pharyngeal swab has been FDA approved for use in pharyngeal samples. There is concern that NAAT techniques can be false positive for N gonorrhoeae due to cross-reaction with the nucleic acid sequences of related organisms, such as N. meningitides. 24 In the present study, all gonococcal infections of the pharynx were confirmed by culture and/or two or more NAATs targeting different sets of primers, suggesting that the high rate of pharyngeal infection was not due to false positive cross-reactivity.In conclusion, men and women who report a lifetime history of receptive anal intercourse have high rates of extragenital infection, both rectal and pharyngeal. Screening men who have sex with men using only urogenital specimens will miss a high number of extragenital infections. Careful history taking will help to identify both men and women at risk of extragenital disease, and site-appropriate testing using NAAT techniques should be considered. References: 1) CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2015;64(RR3):1-137.2) CDC. 2013 Sexually Transmitted Diseases Surveillance, Figure 2. Chlamydia — rates of reported cases by region, United States, 2004–2013 Available at: Accessed 6/5/20153) CDC. Press Release: National Estimate Shows Not Enough Young Women Tested for Chlamydia Available at: accessed on 6/5/20154) Gindi RM, Ghanem KG, Erbelding EJ. Increases in oral and anal sexual exposure among youth adolescents attending sexually transmitted diseases clinics in Baltimore, Maryland. J Adolescent Health 2008;42(3)307-8.5) Tian LH, Peterman TA, Tao G, et al. Heterosexual anal sex activity in the year after a STD clinic visit. Sex Transm Dis 2008;35:905-9.6) Hunte T, Alcaide M, Castro J. Rectal infections with chlamydia and gonorrhoea in women attending a multiethnic sexually transmitted diseases urban clinic. Int J STD AIDS. 2010 Dec;21(12):819-22.7) Javanbakht M, Guerry S, Gorbach PM, et al. Prevalence and correlates of heterosexual anal intercourse among clients attending public sexually transmitted disease clinics in Los Angeles County. Sex Transm Dis 2010;37(6):369-76.8) Chandra A, Mosher WD, Copen C, et al. Sexual behavior, sexual attraction, and sexual identity in the United States: data from the 2006–2008 National Survey of Family Growth. Natl Health Stat Report 2011;36:1-36.9) Herbenick D, Reece M, Schick V, et al. Sexual behavior in the United States: results from a national probability sample of men and women ages 14-94. J Sex Med 7(suppl. 5):255-265.10) Halperin DT. Heterosexual anal intercourse: prevalence, cultural factors, and HIV infection and other health risks, part I. AIDS Patient Care STDs 1999;13(12):717–30.11) Leichliter J, Chandra A, Liddon N, et al. Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States. J Infect Dis 2007;196(12):1852–9.12) Papp JR, Schachter J, Gaydos CA, et al. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014 MMWR Recomm Rep. 2014;63(0)1-19.13) Ivens D, Macdonald K, Bansi L, et al. Screening for rectal chlamydia infection in a genitourinary medicine clinic. Int J STD AIDS 2007;18:404-6.14) Annan NT, Sullivan AK, Nori A, et al. Rectal chlamydia – a reservoir of undiagnosed infection in men who have sex with men. Sex Transm Infection 2009;85(3):176-9.15) Kent CK, Chaw JK, Wong W, et al. Prevalence of rectal, urethral and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis 2005; 41(1):67-74.16) Patton ME, Kidd S, Llata E, et al. Extragenital gonorrhea and chlamydia testing and infection among men who have sex with men – STD surveillance network, United States 2010 – 2012. Clin Infec Dis 2014:58(11);1564-70.17) Peters RP, Nijsten N, Mutsaers J et al. Screening of oropharynx and anorectum increases prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection in female STD clinic visitors. Sex Trasm Dis 2011;38(9);783-7.18) Cosentino LA, Campbell T, Jett A, et al. Use of nucleic acid amplification testing for diagnosis of anorectal sexually transmitted infections. J Clin Microbiol 2012;50(6):2005-8.19) CDC. Clinic-based testing for rectal and pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis Infections by community-based organizations - five cities, United States, 2007. MMWR Morb Mortal Wkly Rep. 2009;58(26):716-9.20) Giannini CM, Kim HK, Mortensen J et al. Culture of non-genital sites increases the detection of gonorrhea in women. J Pediatr Adolesc Gynecol. 2010 Aug;23(4):246-52.21) Kinghorn GR, Rashid S. Prevalence of rectal and pharyngeal infection in women with gonorrhoea in Sheffield. Br J Vener Dis 1979; 55(6):408-10. 22) Barry PM, Kent CK, Philip SS, et al. Results of a program to test women for rectal chlamydia and gonorrhea. Obstet Gynecol 2010;115(4): 753–9.23) Hutt DM, Judson FN. Epidemiology and treatment of oropharyngeal gonorrhea. Ann Intern Med 1986; 104(5):655-8.24) Nagasawa Z, Ikeda-Dantsuji Y, Niwa T, et al. Evaluation of APTIMA Combo 2 for cross-reactivity with oropharyngeal Neisseria species and other microorganisms. Clin Chim Acta. 2010 May 2;411(9-10):776-8.Table 1: Patient CharacteristicsMen Number (%) n = 224WomenNumber (%)n = 175p valueEnrollment Site<0.001 ACHD STD Clinic216 (96.4%)137 (78.3%) MWH or other8 (3.6%)38 (21.7%)Age, years (median, range)26 (18, 62)27 (18, 49)0.24Hispanic, Latino13 (5.8%)9 (5.1%)0.83Predominant Race0.001 Caucasian158 (70.5%)91 (52.0%) Black49 (21.9%)65 (37.1%) Other17 (7.6%)19 (10.9%)Lifetime History of Sexual Activity0.30 Men only171 (76.3%)125 (71.4%) Both men and women53 (23.7%)50 (28.6%)Number of male partners (median, range) Past 30 Days 1.5 (0, 15)1 (0, 5)<0.001 Past 12 Months5 (0, 100)2 (0, 30)<0.001Number of female partners (median, range) Past 30 Days 0 (0, 4)0 (0, 2)0.96 Past 12 Months0 (0, 50)0 (0, 4)0.57Sexual Activity Receive Oral Sex222 (99.1%)172 (98.3%)0.66 Perform Oral Sex220 (98.2%)170 (97.1%)0.51Condom Use During Anal Sex194 (86.6%)66 (37.7%)<0.001 Condom Use with last contact106 (47.3%)35 (20.0%)<0.001Traded Sex for money, drugs, food, etc8 (3.6%)13 (7.4%)0.11Females Only: Last vaginal intercourse with man, days median, range)7 (0, 998)Anal Sex after vaginal sex without condom change N/A29 (22.3%) Rarely (0-2/10)24 (13.7%) Occasionally (3-5/10)18 (10.3%) Most of the time (6-9/10)22 (12.6%) Always (10/10)72 (41.1%)Table 2: Symptoms experienced by site of infectionMenNo infection(n=144)Positive GC(n = 51)PGCPositive CT(n = 49)PCT Any Site41 (28.5)24 (47.1)0.0221 (42.9)0.08 Rectal17 (11.8)10 (19.6)0.1710 (20.4)0.15 Pharynx21 (14.6)8 (15.7)0.827 (14.3)>0.99 Urinary10 (6.9)12 (23.5)0.0019 (18.4)0.08WomenNo infection(n=150)Positive(n = 6)Positive(n = 21) Any Site66 (44.0)5 (83.3)0.0912 (57.1)0.35 Rectal10 (6.7)0>0.9900.61 Pharynx17 (11.3)4 (66.7)0.0037 (33.3)0.01 Vaginal58 (38.7)4 (66.7)0.228 (38.1)>0.99P = p valueTable 3: Prevalence of GC and CT by siteGC Number Positive (%)CT Number Positive (%)Anatomic SiteMen (n=224)Women (n=175)PGCMen (n=224)Women (n=175)PCT Any Site51 (22.8)6 (3.4)<0.00149 (21.9)21 (12.0)0.01 Rectal26 (11.6)4 (2.3)<0.00139 (17.4)19 (10.9)0.09 Pharynx37 (16.5)4 (2.3)<0.0015 (2.2)3 (1.7)>0.99 Urogenital12 (5.4)5 (2.9)0.3210 (4.5)18 (10.3)0.03P = p valueFigure 1: Distribution of C. trachomatis by testing site in menFigure 2: Distribution of N. gonorrhoeae by testing site in menFigures 3: Distribution of C. trachomatis by testing site in womenFigures 4: Distribution of N. gonorrhoeae by testing site in women ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download