STD Testing of HIV-infected MSM at Eight U.S. Clinics

Background:
To protect the health of HIV-infected persons and to prevent HIV transmission, the Centers for Disease Control and Prevention and the Infectious Diseases Society of America published guidelines for the care of HIV-infected persons in 2004. These guidelines included recommendations for sexually transmitted diseases (STD) testing.

Objective:
To determine whether providers who care for HIV-infected men who have sex with men (MSM) are following guidelines and testing patients for syphilis, gonorrhea, and Chlamydia.

Method:
We conducted an evaluation of STD testing of HIV-infected MSM at eight clinics in six U.S. cities with high rates of HIV and STD among MSM. A provider survey (N=128) asked clinicians how frequently they tested asymptomatic patients for STD who reported unprotected sex, and how often they ask about consistent condom use. A patient survey (N=507) queried patients if they were tested for an STD during the past year. Clinical visits (N= 2042) were abstracted to determine STD testing rates.

Result:
Most providers always or sometimes asked about condom use (97.1%). Among those, 89.5% indicated that they would always or sometimes test an asymptomatic HIV-positive MSM who reported unprotected sex for syphilis; 87.6% would test for gonorrhea; and 83.8% would test for Chlamydia. Among patients, 52.7% reported that they were offered a syphilis test in the past year; 37.4% were offered a gonorrhea test; and 34.1% were offered a Chlamydia test. A preliminary analysis of data from medical record abstractions found that 58.8% of patients had a syphilis test during 2004-2006.

Conclusion:
Although most providers reported that they at least sometimes test asymptomatic MSM for STD, patient surveys and medical record abstractions found that optimal STD testing according to guidelines was not done.

Implications:
Interventions are needed to assure that guidelines for STD testing in HIV-infected MSM are followed.