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Background:Routine STD screening is recommended for HIV-infected MSM. STD co-infection can increase the risk of HIV transmission. HIV-infected persons might also be at increased risk of acquiring STDs because of the continuation of high risk sexual behaviors.
Objectives:To determine the percentage of positive chlamydia and gonorrhea screening tests among asymptomatic HIV-infected MSM by anatomic site and test type.
Methods:We abstracted medical records of HIV-infected MSM receiving clinical care in eight large U.S. HIV clinics. We estimated: 1) the number of visits during 2004-2006 where an asymptomatic patient was screened for chlamydia at the urethral or rectal sites, or for gonorrhea at the urethral, rectal, or pharyngeal sites, and 2) the proportion of these tests that were positive. Screening tests used included nucleic acid amplification tests (NAATs), DNA hybridization tests, or culture.
Results:Medical records were abstracted for 1334 patients who made 14,659 visits from 2004-2006. Over 93% of the visits were made by patients who were asymptomatic at all anatomic sites, but screening was infrequent with screening at any anatomic site occurring at ? 17% of visits. Among HIV-infected MSM, the prevalence of urethral chlamydia was 2.3% and rectal chlamydia was 10.2%. The prevalence of urethral gonorrhea was 5.0%, rectal gonorrhea was 3.9%, and pharyngeal gonorrhea was 4.5%. Pharyngeal gonorrhea positivity varied substantially by NAAT compared to non-NAAT (11.5% (6/52) vs. 0.7% (1/150)). Test results were missing for about 20% of rectal and pharyngeal gonorrhea tests, and 93% of these missing results were for culture tests.
Conclusions: Despite moderate to high chlamydia and gonorrhea prevalence at all anatomic sites among asymptomatic HIV-infected MSM, screening rates were suboptimal. The prevalence of these infections highlights the importance of routinely screening sexually active patients.
Implications for Programs, Policy, and/or Research: The most important barrier to screening is the lack of FDA-cleared NAAT tests for non-urethral sites.