Gonorrhea testing of anus and throat is urged.
Gonorrhea incidence in the United States as a whole and in California specifically had been declining for 3 decades before starting to climb in about the year 2000, Dr. Gail Bolan said at a meeting on HIV management sponsored by the University of California, San Francisco.
A recent study in San Francisco of men who have sex with men reported that if only urine and urethral screening were performed in those men, about 65% of gonorrhea cases would be missed, Dr. Bolan said.
The study found that 85% of the rectal infections were asymptomatic, indicating the possibility that these infections may be an important factor fueling the incidence increase (Clin. Infect. Dis. 2005;41:67-74).
Additionally, the study reported that 53% of chlamydial infections were at nonurethral sites, Dr. Bolan noted.
In part because of these concerns, the Centers for Disease Control and Prevention recently updated its sexually transmitted diseases guidelines to include what to ask when taking a sexual history to screen for disease. According to the new guidelines, the sexual history taking must include specific questions regarding what is known as the "5 P's": partners, pregnancy protection, protection from sexually transmitted diseases, practices, and past history of sexually transmitted diseases.
Because testing for gonorrhea at the rectal and pharyngeal sites requires culturing, physicians need to make sure they have culturing available, she noted.
Dr. Bolan also said that fluoroquinolone-resistant gonorrhea continues to be a problem. The CDC guidelines recommend that fluoroquinolones not be used in men who have sex with men or in areas where fluoroquinolone resistance is high.
BY TIMOTHY F. KIRN
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|Title Annotation:||Infectious Diseases|
|Author:||Kirn, Timothy F.|
|Publication:||Internal Medicine News|
|Date:||Mar 15, 2007|
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