Infection Positivity Among Sexual Contacts to Chlamydia and Gonorrhea, STI Surveillance Network, 2021-2023

Patients reporting sexual contact with a person(s) with chlamydia (CT) and/or gonorrhea (NG) are at increased risk of acquiring these sexually transmitted infections (STIs). Presumptive antimicrobial therapy is recommended for sexual contacts, but concerns have been raised about unnecessary antibiotic use.

We reviewed visits of patients who reported sexual contact to a partner with CT or NG ("contacts") from January 2021 to October 2023 in 10 STI clinics. We calculated CT and NG positivity, stratified by 3 patient groups (women, men who have sex with men, and men who have sex with women only [MSW]) and symptomatic status.

Overall, 11,072 (6.8%) CT and/or NG contacts were identified (7660 [4.7%] CT contacts and 4988 [3.1%] NG contacts). Chlamydia positivity among CT contacts was 35%; NG positivity among NG contacts was 31%. Chlamydia positivity did not differ by symptomatic status across patient groups. Gonorrhea positivity was higher for symptomatic versus asymptomatic men who have sex with men (34% [95% confidence interval {CI}, 31%-37%] vs. 28% [95% CI, 26%-30%]) and MSW (37% [95% CI, 33%-41%] vs. 23% [95% CI, 20%-27%]), but not in women (38% [95% CI, 33%-43%] vs. 37% [95% CI, 32%-42%]).

Substantial CT/NG positivity among sexual contacts to CT or NG was observed. Among CT contacts, CT infection was most often detected in MSW; among NG contacts, NG infection was most often detected in women. However, ~60% did not have either CT or NG. The use of point-of-care tests in this population may optimize antimicrobial use while prioritizing individual clinical care.