Extragenital STI Testing of Sexually Active HIV+ MSM in New York State: Room for Improvement

Background: CDC STD Treatment Guidelines recommend that MSM and other high-risk HIV+ patients receive at least annual testing for asymptomatic gonorrhea and Chlamydia at each anatomic site of exposure. We have developed quality measures to determine extragenital (pharyngeal and rectal) STI testing rates among sexually active, HIV+ MSM in NYS. 

Methods: The NYSDOH annually collects performance measurement data from HIV ambulatory care programs, which self-report using a web-based platform, eHIVQUAL. In 2011, new measures of sexual history taking and extragenital STI testing were developed. 186 HIV ambulatory care programs abstracted medical records from a random sample of active patients in care, calculated to achieve CI=90% ±8%. The statewide sample included 2361 MSM out of 9943 eligible patients. Indicator data was analyzed using SAS.

Results: In 2011, 1935 (82%) of HIV+ MSM were assessed for any sexual activity and 1412 (73%) reported that they were sexually active. Among 649 MSM asked about oral sexual activity, 561 (86%) reported oral sex, and the pharyngeal gonorrhea and Chlamydia testing rates among these MSM were only 15% and 10%. Of these tests, 8% and 10% were positive, respectively. Among 862 MSM asked about anal sexual activity, 821 (95%) reported anal sex, and the rectal gonorrhea and Chlamydia testing rates among these MSM were similarly low at 12% and 11%. Of these tests, 10% and 13% were positive, respectively. 

Conclusions: Extragenital testing rates are very low among HIV+ MSM specifically reporting oral or anal sex. The relatively high positivity rates of extragenital STI tests, including pharyngeal Chlamydia, indicate that addressing barriers to extragenital testing should be a priority focus for improving care among the HIV+ and at-risk MSM populations moving forward. Timely detection and treatment of STIs are needed to reduce onward STI and HIV transmission.