Impact of sex-based differences in testing practices on Chlamydia trachomatis and Neisseria gonorrhoeae infection rates in military service members

BackgroundChlamydia trachomatis and Neisseria gonorrhoeae infections impose a significant burden to the military. In previous studies, women service members had higher rates of both these infections as compared to men for unclear reasons. This study evaluated if sex-based differences in infection rates for chlamydia and gonorrhea were due to sex-based differences in testing practices.MethodsA retrospective chart review was conducted on military service members who underwent testing for chlamydia and gonorrhea at Joint Base San Antonio between June 1, 2023 and September 31, 2023. The local electronic health record database was queried to determine patient demographics, clinical setting, indications for testing, and positivity rates.ResultsA total of 1620 (43%) patients were included for analysis. The cohort was predominantly women (67.5%) and enlisted (84.2%) with a median age of 27 years [IQR: 23-32]. Men were more likely to be tested for patient driven factors, such as symptoms (41.2%) or patient request (24.5%). Women were most frequently tested due to clinical algorithm (53.0%). Men were more likely to test positive for both chlamydia (8.7% vs 3.9%, p = <0.001) and gonorrhea (2.8% vs 0.4%, p = <0.001).ConclusionsAlthough women were more frequently tested for chlamydia and gonorrhea infections, men had significantly higher positivity rates, with more patient-driven indications for testing. The result of this study implies that sex-based testing practice differences in our study population might partially account for the higher rates in men. Importantly, it supports the need for future studies to evaluate the effectiveness of screening men in military settings.