Optimizing screening for anorectal, pharyngeal, and urogenital C. trachomatis and N. gonorrhoeae infections in at risk adolescents and young adults in New Orleans, Louisiana and Los Angeles, California, USA.

BACKGROUND Public health organizations have inconsistent recommendations for screening adolescents and young adults for Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) infections. Guidelines suggest different combinations of anorectal, pharyngeal, and urogenital testing based on age, sex, and sexual activity. Further evaluation of how identity and behaviors impact the anatomic distribution of C. trachomatis and N. gonorrhoeae infection is needed to optimize future screening practices. METHODS We assessed the positivity of C. trachomatis and N. gonorrhoeae infections at different anatomic sites in a cohort of at-risk sexually active adolescents and young adults between 12-24 years old in New Orleans, Louisiana and Los Angeles, California. Participants were tested for C. trachomatis and N. gonorrhoeae at three sites (anorectum, pharynx, and urethral/cervix) every four months using self-collected swabs. We stratified anatomic distributions of infection into four gender and sexual behavior categories: (i) cisgender men who have sex with men and transgender women (MSMTW), (ii) cis-heterosexual males, (iii) cis-heterosexual females, and (iv) gender minorities assigned female at birth. RESULTS While three-site testing detected all infections, two-site (anorectum and urethra/cervix) testing identified 92-100% of C. trachomatis or N. gonorrhoeae infections in participants assigned female at birth and cis-heterosexual males. For MSMTW, two site anorectal and pharyngeal testing versus single site anorectal testing increased the proportion of individuals with either infection from 74 to 93%. CONCLUSION Sexual behavioral and gender identity factors may influence detection of C. trachomatis and N. gonorrhoeae infections at specific anatomic testing sites. Testing guidelines should incorporate sexual behavior and gender identity.