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Extragenital Screening

Don’t forget to swab! Among men who have sex with men, 84% of gonorrhea and chlamydia infections would be missed with urine-only screening1. Make sure your clients are screened for gonorrhea and chlamydia of the throat and rectum.

What:	Extragenital Screening for Gonorrhea and Chlamydia
Where:	Rectum and throat
Who:	Men who have sex with men (MSM), transgender women, people living with HIV, and people on PrEP who report having receptive anal and/or oral sex
When:	At least annually, or every 3 to 6 months as needed based on exposure
Why:	When urine-only screening is performed, up to 90% of rectal gonorrhea and 77% of rectal chlamydia infections remain untreated¹. HIV-negative men diagnosed with rectal infections are excellent candidates for PrEP, because they have a high risk of HIV infection
How:	Swab specimen (self or clinician-collected swab)

The California Prevention Training Center supports clinics and providers in implementing rectal and pharyngeal STI screening.

For more information, contact us.

Resources for Providers

FDA clears first diagnostic tests for extragenital testing for chlamydia and gonorrhea, FDA New Release
May 23, 2019

Extragenital Chlamydia and Gonorrhea Among Community Venue–Attending MSM, CDC MMWR
April 11, 2019

CA Department of Public Health, Dear Colleague Letter
February 20, 2019

HIV incidence among men with and those without sexually transmitted rectal infections, Clinical Infectious Diseases
October 15, 2013

National Coalition of STD Directors – Extragenital Testing

NYC Department of Health and Mental Hygiene – STI’s Among MSM Protocol Card

Resources for Clinics

Self Swab Instructional Posters:

Rectal, Throat, and Vaginal Self-Swab

Rectal Self-Swab

Throat Self-Swab

Vaginal Self-Swab

CDC Recommendations for Laboratory-Based Detection of Gonorrhea and Chlamydia, March 14, 2014

Verification of Patient Self-Collected Extragenital Nucleic Acid Amplification Tests

Resources for Patients

CDC Just Diagnosed – Gonorrhea and Chlamydia

CDC PrEP Resources

Please PrEP Me – Provider Locator

Building Healthy Online Communities – Sexual Health Information

Marcus JL, Bernstein KT, Kohn RP, Liska S, Philip SS. Infections missed by urethral-only screening for chlamydia or gonorrhea detection among men who have sex with men. Sexually transmitted diseases. 2011 Oct 1;38(10):922-4.

Congenital Syphilis Algorithm

Video example of a disease intervention interview linking a person co-infected with syphilis and HIV to care, and providing partner services.

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Extragenital Screening Resources

Extragenital (rectum and throat) gonorrhea and chlamydia screening resources for providers, clinics, and patients.

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Taking A Sexual History – Using the 5Ps (A Practical Guide for Clinicians)

Dr. Christoper Ried, Medical Director of HIV/STD Services for Orange County, demonstrates a sexual health history screening using the 5Ps of taking a sexual history.

Video video

Secondary Syphilis Patient Evaluation Algorithm

Algorithm to evaluate patients for secondary syphilis. Includes sexual history taking and physical exam, diagnostic work-up, treatment and follow-up, and reporting and partner management.

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Primary Syphilis Patient Evaluation Algorithm

Algorithm to assist in evaluating patients for primary syphilis.

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Minor Consent and Confidentiality for Sexual Health Services in California: A Training for Clinical Settings

A free, on-demand training for California clinical settings that provides participants with an overview of CA laws that guarantee minors’ right to access confidential sexual health services and the roles that clinical practices and healthcare systems have in ensuring these protections.

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S3 E12: Four Decades of Sexual Health: History of the CAPTC

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Director of the CAPTC Dana Cropper sits down with Gail Bolan, MD, and Alice Gandelman to discuss the founding of the CAPTC and its work in supporting sexual healthcare providers over the last 33 years. We learn about the forces that shaped the sexual healthcare field. Our guests unpack how the CAPTC developed alongside the HIV/AIDS epidemic in the late 1980s, the surprising relationship between HIV work and STI response, strategies to meet sexual healthcare needs both within and outside of sexual health clinics, and the ever-present need for greater training for providers around testing and treatment of STIs. We learn about how behavioral interventions were centered in response to the HIV/AIDS epidemic, and the importance of centering social determinants of health and larger structural forces in prevention and treatment efforts. They also discuss their hopes for opening up discussions about sexual health and de-stigmatizing the topic in the greater community.

Read the transcript of the episode here.

Resources:

HHS/Viral Hepatitis Action Plan

Ending the HIV Epidemic in the US (EHE)

Provision of Quality of STD Services (CDC) 2020

San Francisco City Clinic

Health HIV

National Coalition for Sexual Health

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Gail Bolan, MD, was the Director of the Division of STD Prevention at the Centers for Disease Control and Prevention (CDC) from 2011 through 2020. Prior to joining CDC, she directed the California Prevention Training Center for 23 years. She served as the Chief of the STD Control Branch at the California Department of Public Health and the Director of the San Francisco City and County STD Prevention and Control Program from 1997 to 2011 as well as Medical Director of the San Francisco City Clinic from 1987 to 1997. 

Alice Gandelman was the Director of the CAPTC from 1994 through 2021. She oversaw growth and development of CAPTC in numerous training and capacity-building programs in STD, HIV, sexual, and reproductive health.

California Guidelines for Suspected Gonorrhea Treatment Failure

Discusses treatment of uncomplicated gonorrhea and what clinicians should do in cases of potential treatment failures.

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Use of Treponemal Immunoassays for Screening and Diagnosis of Syphilis

Guidance for medical providers and laboratories in California. Includes laboratory procedures and reporting, results interpretation, congenital syphilis, integration of HIV and other STI testing, partner management, serologic follow-up, public health reporting, and clinical consultation options.

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