Therefore, we sought to investigate the correlates of pharyngeal gonorrhea among young people attending public STD clinics, including individual and partnership level behaviors, knowledge, and attitude. Understanding factors that place young people at increased risk for pharyngeal gonorrhea is not only critical to understanding the contribution of these infections to the maintenance of high endemic rates of gonorrhea among young people, but will also help us develop more appropriate STI risk reduction messages and interventions. Very little is known about the epidemiology of pharyngeal gonorrhea among young people. 21 Consequently, gonorrhea infections of the pharynx require a different treatment strategy further stressing the importance of the pharynx as a reservoir for continual transmission of gonorrhea and a potential source of drug resistant strains of gonorrhea. Moreover, gonococcal infections in the pharynx are more difficult to eradicate than infections at urogenital sites. 20 These data suggest that pharyngeal infections may serve as an important reservoir and source of urethral gonorrhea, and that oral sex may be contributing to the ongoing transmission of gonorrhea between men and their female sex partners. 17- 20 In one study, the prevalence of pharyngeal gonorrhea among men whose only urethral exposure was receiving oral sex from women was 3.1%, which was comparable to the 4.1% prevalence noted among MSM seen at the same clinic. 16 Furthermore, there is increasing evidence of pharynx to genital transmission of gonorrhea. Transmission of gonorrhea to the pharynx is thought to be more efficient through oral-penile contact than oral-vaginal contact. In fact, current screening guidelines recommend screening for pharyngeal gonorrhea among MSM who report receptive oral sex, though no such recommendations are in place for non-MSM populations. 10- 14 Although the majority of women and heterosexual men report oral sex, most clinics do not routinely offer screening of the oropharynx. 5- 7 Data among heterosexuals are limited, however, pharyngeal gonorrhea has been noted in 3-7% of heterosexual men and 2-10% of women. Among men who report sex with men (MSM), pharyngeal gonorrhea is well documented with the prevalence ranging from 2-11%. Most reported cases of gonorrhea are based on urogenital testing and information on the epidemiological significance of pharyngeal infections is limited. 1 Gonorrhea can cause substantial morbidity and serious health complications, particularly in women, including ectopic pregnancy, chronic pelvic pain, infertility and can increase the risk of transmission and acquisition of HIV. 1 Additionally, gonorrhea infections disproportionately affect young people, with20-24 year-old men and women highest rates of gonorrhea in 2016 (616.8 and 595.5 per 100,000 respectively). In 2016over 460,000 cases of gonorrhea were reported, which represents a 19% increase since 2015. Infections with Neisseria gonorrhoeae are a significant public health problem and represent the second most common reportable disease in the United States.
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