![]() Participants received an email or text message each week prompting them to complete the survey. ![]() Although we requested that participants complete study procedures every 7 days, we allowed up to 3 days beyond the intended collection date for reimbursement purposes and included all returned specimens and surveys in data analyses. All other participants began data collection approximately 1 week after their enrollment visit, and we allowed participants to choose the day of the week for personal convenience. Participants who tested positive for gonorrhea or chlamydia at their enrollment visit were asked to wait for 2 (gonorrhea) or 3 (chlamydia) weeks after treatment before beginning weekly specimen and data collection. We asked participants to get STI care at PHSKC SHC throughout the study period and requested their consent to access medical records for clinical STI testing and treatment data.Įach week at home, participants collected rectal and pharyngeal swab samples and completed an online survey. The study team emphasized that weekly study specimens would not be tested in real time, and that study participation should not supplant participants’ usual routine STI screening. Study personnel taught participants how to self-collect pharyngeal and rectal specimens using the Aptima universal collection kit, package specimens for shipping, and access the password-protected weekly survey. Unless the participant had documented clinical sexually transmitted infection (STI) testing within 3 weeks of enrollment, all participants were also tested for syphilis, HIV, and rectal and pharyngeal gonorrhea and chlamydia. ![]() At the enrollment visit, participants underwent face-to-face interview to collect demographic and clinical data, followed by an electronic sexual behavior survey conducted on a computer or participants’ mobile telephone. This prospective study consisted of an enrollment visit, 48 weekly specimens and surveys, and an exit visit. We aimed to define the true duration of pharyngeal gonococcal infection-from acquisition to clearance-using highly sensitive nucleic acid amplification tests (NAATs) to serially test a cohort of MSM. The third study exploited the epidemiologic principal that the duration of an infection should equal the prevalence divided by incidence, and suggested that the duration is closer to 4 months. These problems are compounded by the low sensitivity of cultures in identifying pharyngeal gonorrhea. However, their study design is subject to competing biases, since the period from infection to diagnosis is ignored, and cross-sectional enrollment at time of diagnosis tends to oversample long-duration infections (ie, length-time bias). Two studies conducted in the 1970s assessed the time from detection of infection to resolution using gonococcal culture and estimated that pharyngeal infections are typically transient, with a median duration of 1–6 weeks. To date, 3 studies have attempted to define the duration of pharyngeal gonorrhea, each with significant limitations. However, the extent to which gonococcal infection at the pharynx sustains population-level transmission is dependent not only on its prevalence but also on the duration of infection, a basic epidemiologic parameter needed to define the reproductive number. Among men who have sex with men (MSM), >10% have positive screening results, and the limited data suggest that this proportion is 2%-10% for women and heterosexual men, yet among heterosexual male and female contacts for gonorrhea, 20%–50% have positive results at throat testing. To date, the theory of the pharyngeal reservoir has been primarily based on the infection’s commonality. Some have theorized that Neisseria gonorrhoeae in the pharynx serves as a reservoir, allowing for sustained community transmission. Gonorrhea cases in the United States increased >60% between 20. ( See the Editorial Commentary by Adamson and Klausner on pages 583–5.)
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