From the Guidelines
Oropharyngeal gonorrhea and chlamydia infections are rarely symptomatic, with approximately 90-95% of cases being asymptomatic. When symptoms do occur in oropharyngeal gonorrhea (about 5-10% of cases), they typically present as pharyngitis with sore throat, redness, or exudate. Oropharyngeal chlamydia is even less likely to cause symptoms, with fewer than 5% of infections producing noticeable effects. This high rate of asymptomatic infection is concerning from a public health perspective because it allows these infections to spread undetected. The asymptomatic nature of these infections is due to the adaptation of these bacteria to colonize mucosal surfaces without triggering significant inflammatory responses in many cases.
Key Points
- The majority of gonorrhea and chlamydia infections are asymptomatic, with studies suggesting that 68%-92% of men with gonorrhea and 70% of women with chlamydia exhibit no symptoms 1.
- The lack of symptoms does not mean these infections are benign, as untreated infections can still be transmitted to partners and may potentially spread to other sites in the body.
- Routine screening of the oropharynx in high-risk individuals is recommended, regardless of symptoms, particularly for those engaging in oral sex.
- The US Preventive Services Task Force recommends screening for chlamydia and gonorrhea in certain populations, including sexually active women under the age of 25 and men who have sex with men 1.
Implications for Practice
The high rate of asymptomatic infection highlights the importance of routine screening and prevention efforts. Clinicians should consider the risk factors for gonorrhea and chlamydia, including age, sexual history, and behavioral factors, when determining which patients to screen. Additionally, patients who are diagnosed with gonorrhea or chlamydia should be instructed to abstain from sexual intercourse until after they and their sex partners have completed treatment and no longer have symptoms.
Prevention and Control
Prevention and control of gonorrhea and chlamydia require a multifaceted approach, including education, screening, and treatment. Clinicians should educate patients about the risks of these infections and the importance of safe sex practices, such as using condoms and limiting the number of sexual partners. Routine screening and prompt treatment of infected individuals can help reduce the spread of these infections and prevent long-term complications.
From the Research
Gonorrhea and Chlamydia Oropharyngeal Infections
- The majority of gonorrhea and chlamydia oropharyngeal infections are asymptomatic 2, 3
- A study found that the prevalence of pharyngeal gonorrhea and chlamydia among men who have sex with men (MSM) was 9.5% and 1.4%, respectively, with most cases being asymptomatic 4
- The incidence of oropharyngeal gonorrhea and chlamydia among MSM was found to be 62 and 9 per 100 person-years, respectively, with a median duration of incident oropharyngeal infection with gonorrhea of 28 days 5
- The duration of gonorrhea infection at the pharynx was estimated to be around 114-138 days, while chlamydia infection at the pharynx had a longer duration of around 667 days 3
Risk Factors and Screening
- The risk of oropharyngeal gonorrhea increased with an increased number of kissing partners and penile-oral sex partners 5
- Current screening guidelines recommend screening for gonorrhea and chlamydia at least once a year in MSM, but this may only detect around 30% of incident pharyngeal gonorrhea cases 3
- Reducing screening interval for gonorrhea and chlamydia in high-prevalence populations has been proposed to address antimicrobial stewardship, but this remains controversial 6