Predictors of STD Testing Among Asymptomatic HIV-Infected Men Who Have Sex with Men

Background: National guidelines recommend at least annual STD screening of asymptomatic, sexually active HIV-infected MSM.

Objectives: To identify patient characteristics associated with screening for syphilis, chlamydia, or gonorrhea among HIV-infected MSM receiving care in HIV clinics.

Methods: Medical records were abstracted of HIV-infected MSM receiving clinical care in eight large U.S. HIV clinics. Asymptomatic patients who were screened for syphilis with an RPR or VDRL test, or for chlamydia or gonorrhea at any anatomic site, in 2005 were compared to asymptomatic patients who were not screened. Multivariate logistic regression models were used to assess the associations between patient and clinic characteristics and STD screening.

Results: In 2005, 76% of asymptomatic patients had at least one syphilis test, and 24% had at least one chlamydia or gonorrhea test at the urethral, rectal, or pharyngeal site. Syphilis and chlamydia or gonorrhea screening was significantly associated with increasing number of visits and the clinic where the patients received care. Syphilis screening did not vary significantly by race and ethnicity. Chlamydia or gonorrhea screening was significantly more likely to be done in patients of multiple/unknown race compared to white non-Hispanic patients (aOR 1.6, 95% CI 1.1-2.5); patients aged 40 years or younger compared to older patients (aOR 2.3, 95% CI 1.7-3.1); and patients with documented evidence of sexual activity in the preceding 18 months (aOR 1.8, 95% CI 1.3-2.5).

Conclusions: Different factors were associated with screening for syphilis than for chlamydia or gonorrhea, probably reflecting the different types of specimen collection required for diagnosing syphilis compared to chlamydia or gonorrhea. These factors likely account for the higher syphilis than chlamydia or gonorrhea screening coverage.

Implications for Programs, Policy, and/or Research: These data suggest that provider interventions to increase syphilis screening might be different than provider interventions to increase chlamydia or gonorrhea screening in this population.