Background: The Virginia Department of Health began offering extragenital gonorrhea (GC) screening via Nucleic Acid Amplification Testing (NAAT) in mid-2017 for clients attending health department clinics. We assessed trends in site-specific extragenital screening over time and evaluated the value of performing routine extragenital screening in this setting.
Methods: We analyzed GC NAAT results for all laboratory tests ordered by participating 116 health department clinics in Virginia from 2018 through 2023 (including STI clinics). Analyses were restricted to clients with recorded sex and age; clients younger than 15 years were excluded. We summarized extragenital test counts and results by year stratified by anatomic site, sex, and age.
Results: There were 181,746 client testing events recorded from 2018 to 2023. All received urogenital screening. The proportion of clients screened rectally increased from 4.8% to 11.5%, while pharyngeal screening increased from 18.7% to 45.4%. Male clients were twice as likely as females to receive pharyngeal screening (46.6% vs. 22.2%) and almost five times as likely to be screened rectally (15.5% vs. 3.2%). Positivity was higher among males across all anatomical sites. Among female clients who received any extragenital screening, 3.7% (1,003/27,303) tested positive overall; 1.3% tested positive exclusively at extragenital sites (0.14% rectal, 1.08% pharyngeal, 0.04% both). Among males who received any extragenital screening, 9.1% (2,614/28,586) tested positive overall; 4.8% tested positive exclusively at extragenital sites (1.4% rectal, 2.5% pharyngeal, 0.9% both). Among all extragenitally screened clients testing positive, 34.5% (346/1,003) of females and 52.8% (1,380/2,614) of males were identified solely by extragenital screening. Pharyngeal screening alone identified 35.6% (1,286/3,617) of all infections in this population.
Conclusion: We observed an increase in the proportion of clients receiving extragenital gonorrhea screening. Among gonorrhea-positive clients who received extragenital screening, approximately half of all infections were detected solely through extragenital screening and would have been missed by urogenital screening alone.
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