2A 2 Is HIV PEP a Carrot for Finding STDs?

Tuesday, June 10, 2014: 3:20 PM
Grand Ballroom A/B/C/D1
Charles Fann, n/a, Disease Prevention and Control Section, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, Sally C. Stephens, MPH, Applied Research, Community Health Epidemiology, and Surveillance, San Francisco Department of Public Health, San Francisco, CA, Susan S. Philip, MD, MPH, Disease Prevention and Control Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, Stephanie Cohen, MD, MPH, San Francisco City Clinic, Population Health Division, San Francisco Department of Public Health, San Francisco, CA and Kyle T. Bernstein, PhD, ScM, STD Prevention and Control Section, San Francisco Department of Public Health, San Francisco, CA

Background: San Francisco City Clinic (SFCC) has offered HIV non-occupational Post Exposure Prophylaxis (PEP) for over a decade.  PEP services are the primary reason for visit of a small, high-risk subset of patients.  To describe STD co-morbidity among patients utilizing PEP, we compared STD morbidity between patients seeking PEP services and those seeking general STD care.

Methods: We examined all visits among HIV-negative patients from January 1, 2010 to December 31, 2012 where the patient self-identified their reason for visit as either PEP only or a STD check-up only. MSM categorization was based on self-reported sexual orientation and reported gender of sex partners. STD morbidity included chlamydia, gonorrhea, and early syphilis.    

Results: During the study interval, there were 14,188 visits to SFCC among HIV-negative patients for which either PEP (n=1061) or STD check-up (n=13,127) were selected as the only reason for visit. Higher morbidity was seen among both PEP only visits compared to STD check up only visits (11.1% versus 7.9%, p=0.0003).  A history of a STD diagnosis in the past 12 months was more also likely at PEP only visits compared to STD check-up only visits (17.3% versus 8.11%, p<0.0001). Of the PEP only visits, 88.3% were MSM compared to 42.2% of STD check-up only visits (p<0.0001).  Additionally, patients with PEP only visits were more likely to be white and Hispanic and less likely to be Black compared to patients with STD check-up only visits (p<0.0001).

Conclusions: STD morbidity rates were high among both those seeking PEP and those seeking general STD care.  Integrating a PEP program at an STD clinic is feasible and STD screening should be bundled with PEP provision; PEP services may be a useful tool to identify additional untreated STDs.