High Volume and High Positivity of Chlamydia and Gonorrhea Tests by Anatomic Site from a Large National Laboratory in the United States, 2019-2023.

Abstract

Background: Chlamydia and gonorrhea are among the most commonly reported sexually transmitted infections (STIs) in the U.S. Testing for chlamydia and gonorrhea infection can be conducted by anatomic site (site-specific). Monitoring testing volume and positivity by anatomic site is important.

Methods: Using a large national laboratory dataset, we assessed chlamydia and gonorrhea test volume and positivity by anatomical site in patients aged 15-60 years.

Results: The data contained 45 million tests each for chlamydia and gonorrhea for 2019-2023. Of chlamydia tests, 71.6% were for women. Among women, 0.4%, 1.5%, and 98.1% were performed on rectal, pharyngeal, and urogenital specimens; chlamydia positivity was 7.3%, 2.0%, and 4.3%, respectively. Among men, 10.5%, 13.7%, and 75.8% were performed on rectal, pharyngeal, and urogenital specimens; chlamydia positivity was 8.0%, 1.4%, and 6.3%, respectively. Among people aged 15-24 years, chlamydia positivity was 12.8% for rectal, 3.4% for pharyngeal, and 8.7% for urogenital among women, and 11.6%, 2.4%, and 12.2% among men, respectively. Gonorrhea testing volume overall and by age and sex was similar to that of chlamydia. Gonorrhea rectal, pharyngeal, and urogenital positivity was 3.2%, 2.4%, and 1.0% among women; 6.8%, 5.2%, and 3.3% among men; and 4.3%, 3.0%, and 1.6% among women aged 15-24 years, and 10.5%, 7.2%, and 4.6% among men aged 15-24 years, respectively.

Conclusion: Although men accounted for <30% of overall chlamydia and gonorrhea testing, they accounted for a majority of extragenital testing. High rates of chlamydia and gonorrhea positivity by specimen type among many demographic groups, especially for extragenital specimens from men and young people, highlight the importance of STI prevention in the U.S.