Screening strategies and epidemiology of gonorrhea and chlamydia in sexually active men in Taiwan.

BACKGROUND

Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are prevalent sexually transmitted infections (STIs) among sexually active men. However, data on multi-site infections and optimal screening strategies among men in Taiwan remain limited.

METHODS

This prospective cross-sectional study was conducted at a HIV/STI voluntary counseling and testing center in Taiwan. Sexually active men aged ≥ 18 years were screened for NG and CT at pharyngeal, urethral, and rectal sites using the Xpert® CT/NG assay. Participants completed questionnaires on demographics, sexual behaviors, and symptoms. Four screening strategies were compared with universal three-site testing as the reference standard using McNemar’s test.

RESULTS

Among 336 participants, 169 (50.3%) were younger than 30 years, and 263 (78.3%) were men who have sex with men (MSM). Overall, 21 participants (6.3%) tested positive for NG and 54 (16.1%) for CT; among MSM, the prevalences were 7.6% and 18.3%, respectively. Most infections (76.1%) were extragenital and 65.7% were asymptomatic. Extragenital infections were more likely to be asymptomatic than genital infections (76.5% vs. 31.3%, p = 0.001). In multivariable analysis, anorectal symptoms (adjusted odds ratio [aOR], 6.54; p < 0.001) and recreational drug use (aOR, 3.83; p = 0.010) were associated with gonorrhea, while MSM status was associated with chlamydia infection (aOR, 2.49; p = 0.045). Overall, a brief sexual history–based strategy (universal first-catch urine testing with pharyngeal and rectal testing guided by reported sexual practices) achieved comparable detection rate to universal three-site screening while reducing the number of tests by 13%.

CONCLUSIONS

NG and CT infections among MSM in Taiwan are common, predominantly asymptomatic and extragenital. Routine multi-site screening guided by brief sexual history offers an effective and practical approach to improving STI detection in this population.