(P214) Extragenital chlamydia and gonorrhea among persons diagnosed with mpox in Chicago, Illinois (June 1, 2022-September 17, 2022)

Background: High prevalence of sexually transmitted infections (STIs) and HIV has been reported in the recent monkeypox (mpox) outbreak and has been associated with poor mpox health outcomes. This analysis aims to describe previous and current diagnoses of extragenital gonorrhea and chlamydia among mpox cases in Chicago.

Methods: Surveillance and case investigation data reported between June 1, 2022, and September 17, 2022, in Chicago, Illinois were matched and analyzed across multiple surveillance systems to examine STI and HIV diagnoses among persons with mpox. Descriptive statistics were calculated and presented as absolute number (N) and proportion (%) for patient characteristics and diagnoses. Bivariate analyses were conducted with Chi-squared (χ²) test for comparison of HIV status by site of STI coinfection.

Results: Among 999 persons diagnosed with mpox, 436 (44%) were among people living with HIV (PLH), 276 (28%) had chlamydia (CT), 290 (29%) had gonorrhea (GC), and 668 (67%) had one of any of these coinfections within the previous 12 months of mpox diagnosis. Nearly two-thirds (61%) of coinfected mpox cases identified as gay, bisexual, or other men who have sex with men (MSM). Non-Hispanic Blacks were disproportionately represented among PLH (41%) as compared to those with a previous GC (24%) or CT diagnosis (22%). Of the 374 CT diagnoses, 19 (5%) had pharyngeal CT and 219 (59%) had rectal CT. Of the 447 GC diagnoses, 82 (18%) had pharyngeal GC and 145 (32%) had rectal GC. PLH had a higher prevalence of rectal site of infection as compared to those who were not PLH for both CT (66% vs 52%; p-value=0.01) and GC (37% vs 30%; p-value=0.18).

Conclusions: Rectal CT/GC infections increasing the risk of HIV acquisition is well documented. Correspondingly, rectal site of CT/GC coinfection was the most prevalent among PLH diagnosed with mpox. With increasing concern over GC resistance, targeted extragenital CT/GC screening among individuals presenting with mpox signs or symptoms is needed. Additionally, pre-exposure prophylaxis and mpox vaccination among gay, bisexual, and other MSM is warranted.