(P44) ELEVATION OF CHLAMYDIA AND GONORRHEA PREVALENCE DURING THE COVID-19 PANDEMIC AND THE BENEFICIAL UTILITY OF MULTI-SITE TESTING

Background:
The Center for Disease Control and Prevention (CDC) has highlighted a significant disruption in the infection rate due to the COVID-19 pandemic, with a persistent rise in cases. The recommended primary specimens for males and females are urine and vaginal swabs, yet a large-scale comparison of positivity rates in self-collected specimen types (urine, oral, rectal, and/or vaginal swabs) has not been reported.

Methods:
We analyzed de-identified Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) results from 2019 to 2023. The specimens were self-collected at home or in a non-clinical setting and sent to the laboratory for analysis. We examined the prevalence of NG and CT positivity among 2,693,508 samples from 593,996 individuals, focusing on 4 collection sites.

Results:
The positive prevalences of NG (CT) by year regardless of specimen types from 2019 to 2023 were 2.2, 3.1, 4.1, 4.1, and 4.3% (6.8, 6.6, 6.3, 5.8, and 5.7%), respectively. The trend of NG-positive prevalence increased since the COVID-19 pandemic period, and CT-positive prevalence decreased.  The female NG-positive prevalence was lower (0.6 - 1.2%) than the male (3.0 - 5.3%) with a peak at 2021.  Notably, approximately 80 - 90% of NG-positive males were detected in rectal and/or oral swabs, but not in urine specimens.  Similarly, approximately 45 - 72% of male individuals with CT positive were identified in rectal and/or oral specimens but not in urine. For females, vaginal swab positivity was also compared to urine, rectal, and/or oral specimens, and 16 - 40% of NG-positive were detected in non-vaginal swab specimens, along with 4.1 - 6.1% for CT-positive.

Conclusion:
This retrospective CT/NG study suggested that the COVID-19 pandemic increased the positive prevalence for NG while CT positivity decreased gradually. Although urine and vaginal swabs are the recommended specimen types, testing of multiple sites showed a greater benefit for detecting NG and CT infectivity.