Frequency of Extra-Genital STD Testing in HIV+ Men-Who-Have-Sex-with-Men (MSM) in Care at a NYC Federally-Qualified-Health-Center, 2011

Background: MSM are an at-risk group for chlamydia (CT) and gonorrhea (GC) infections, including extra-genital (EG) CT/GC.  However, studies show that EG infections may be underdiagnosed due to lack of screening. We examined the prevalence of EG CT/GC screening at a Federally-Qualified-Health-Center (FQHC) that primarily serves lesbian, gay, bisexual, and transgender (LGBT) communities to identify opportunities for improvement.  

Methods: We randomly sampled 10% of 3,000 HIV+ MSM with ≥1 clinic visit during 2011. Anatomic sites of CT/GC testing in the year prior to visit were abstracted from medical records, as were demographic factors: age, residential zip code, race/ethnicity, and insurance type.   

Results: In our sample (n=300), the median age was 39 years, 47% (141/300) were Manhattan residents, 18% were Black and most had either government subsidized insurance (78%) or were privately insured (21%).  The prevalence of urethral, rectal and pharyngeal CT/GC testing in the past year was 71% (213/300), 47% (140/300) and 40% (119/300), respectively. Overall, 9% (27/300) of patients tested positive for CT at any anatomic site; 9% (27/300) tested positive for GC at any anatomic site. Among those who had a rectal CT/GC test, 9% (12/140) were positive for GC and 14% (20/140) were positive for CT.  Overall, 9% (27/300) of patients tested positive for CT at any anatomic site; 9% (27/300) tested positive for GC at any anatomic site. 

Conclusions: Extra-genital CT/GC testing was markedly less common than urethral testing for HIV+ MSM attending this LGBT-focused FQHC, likely resulting in missed infections. Further evaluation is needed to characterize missed opportunities for EG CT/GC screening, in order to inform measures to increase screening rates in this at-risk population.