Population-level Benefits of Extragenital Gonorrhea Screening Among Men Who Have Sex With Men: An Exploratory Modeling Analysis. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Earnest, Rebecca; Rönn, Minttu M.; Bellerose, Meghan; Gift, Thomas L.; Berruti, Andrés A.; Hsu, Katherine K.; Testa, Christian; Zhu, Lin; Malyuta, Yelena; Menzies, Nicolas A.; Salomon, Joshua A.
• Is Part Of: Sexually transmitted diseases. Volume 47:Issue 7(2020)
• Publication Date: 2020-07
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000001189
• Languages: English
• ISSNs: 0148-5717

Abstract

Abstract : Background: Men who have sex with men (MSM) are disproportionately burdened by gonorrhea and face high rates of extragenital (rectal and pharyngeal) infection, which is mostly asymptomatic and often missed by urogenital-only screening. Extragenital screening likely remains below Centers for Disease Control and Prevention–recommended levels. Because increasing screening coverage is often resource-intensive, we assessed whether improved extragenital screening among men already presenting at clinics could lead to substantial reductions in prevalence and incidence. Methods: We calibrated an agent-based model of site- and race-specific gonorrhea infection in MSM to explicitly model multisite infection within an individual and transmission via anal, orogenital, and ororectal sex. Compared with current screening levels, we assessed the impact of increasing screening at (1) both extragenital sites, (2) only the rectal site, and (3) only the pharyngeal site among men already being urogenitally screened. Results: All scenarios reduced prevalence and incidence, with improved screening at both extragenital sites having the largest effect across outcomes. Extragenitally screening 100% of men being urogenitally screened reduced site-specific prevalence by an average of 42% (black MSM) and 50% (white MSM), with these values dropping by approximately 10% and 20% for each race group when targeting only the rectum and only the pharynx, respectively. However, increasing only rectal screening was more efficient in terms of the number of screens needed to avert an infection as this avoided duplicative screens due to rectum/pharynx multisite infection. Conclusions: Improved extragenital screening substantially reduced site-specific gonorrhea prevalence and incidence, with strategies aimed at increasing rectal screening proving the most efficient. Abstract : An agent-based model of multisite gonorrhea transmission within an urban United States men who have sex with men population found that improving extragenital (rectal and pharyngeal) screening could substantially reduce anatomical site-specific prevalence and incidence.Supplemental digital content is available in the text.