Oropharyngeal Gonorrhea and Chlamydia Testing in the Pediatric Emergency Department

Gonorrhea and chlamydia (GCCT) are among the most commonly reported sexually transmitted infections (STIs), particularly in adolescents. Screening guidelines recommend only urogenital testing for most patients. With changing trends in sexual practice, we sought to determine whether the addition of oropharyngeal GCCT testing would improve STI detection in our Pediatric Emergency Department (PED). In December 2021, our PED began incorporating routine oropharyngeal testing for all patients undergoing urogenital GCCT testing. This retrospective study of patients ages 13 to 21 years examined patients who underwent both urogenital and oropharyngeal testing from February 2022 to January 2025. McNemar's chi-square test was used to determine percentage differences of combined oropharyngeal and urogenital GCCT testing versus urogenital testing alone. In total, 218 adolescents underwent both urogenital and oropharyngeal testing. The median age was 19 years (interquartile range = 18, 20), and 152 (70%) were female. Ten patients had an oropharyngeal test positive for GCCT but a negative urogenital test. With both urogenital and oropharyngeal testing, there was a significant increase in the overall GCCT positivity rate compared with urogenital testing alone (58 [27%] vs 48 [22%], P = 0.002). By expanding STI testing to include universal oropharyngeal testing, we identified several adolescents with GCCT who might have been missed by standard urogenital screening.