Screening strategies and epidemiology of gonorrhea and chlamydia in sexually active men in Taiwan

BACKGROUND: Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are prevalent sexually transmitted infections (STIs) among sexually active men. However, data on multi-site infections and optimal screening strategies among men in Taiwan remain limited. METHODS: This prospective cross-sectional study was conducted at a HIV/STI voluntary counseling and testing center in Taiwan. Sexually active men aged ≥ 18 years were screened for NG and CT at pharyngeal, urethral, and rectal sites using the Xpert® CT/NG assay. Participants completed questionnaires on demographics, sexual behaviors, and symptoms. Four screening strategies were compared with universal three-site testing as the reference standard using McNemar’s test. RESULTS: Among 336 participants, 169 (50.3%) were younger than 30 years, and 263 (78.3%) were men who have sex with men (MSM). Overall, 21 participants (6.3%) tested positive for NG and 54 (16.1%) for CT; among MSM, the prevalences were 7.6% and 18.3%, respectively. Most infections (76.1%) were extragenital and 65.7% were asymptomatic. Extragenital infections were more likely to be asymptomatic than genital infections (76.5% vs. 31.3%, p = 0.001). In multivariable analysis, anorectal symptoms (adjusted odds ratio [aOR], 6.54; p < 0.001) and recreational drug use (aOR, 3.83; p = 0.010) were associated with gonorrhea, while MSM status was associated with chlamydia infection (aOR, 2.49; p = 0.045). Overall, a brief sexual history–based strategy (universal first-catch urine testing with pharyngeal and rectal testing guided by reported sexual practices) achieved comparable detection rate to universal three-site screening while reducing the number of tests by 13%. CONCLUSIONS: NG and CT infections among MSM in Taiwan are common, predominantly asymptomatic and extragenital. Routine multi-site screening guided by brief sexual history offers an effective and practical approach to improving STI detection in this population.