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Background: Significant research has focused on reducing HIV transmission among persons who inject drugs (PWID). However, among this population, less attention has been paid to sexually transmitted infections (STI) which increase likelihood of HIV acquisition by 2-5-fold. Further, recent data suggest STI are biological markers of evident HIV infection among persons in high-risk sexual networks.
Methods: Eligible participants were 18 years or older who indicated sexual activity and injection drug use in prior month. They completed a self-administered survey assessing risk behaviors within 6 months and provided self-obtained specimens from up to three anatomic sites (oropharynx, urethral/vaginal, rectum). Specimens were tested for chlamydia and gonorrhea using nucleic acid application testing. Chi-square, t-tests, and Mann-Whitney U tests were performed to assess factors associated with screening positive for chlamydia or gonorrhea at any site.
Results: 21 of 120 participants tested positive for STI; 76.2% were women. There were 27 infections by site and organism. A greater proportion of women testing positive were younger, engaged in transactional sex, received condoms from the syringe exchange site, and had a higher median number of sex partners. A greater proportion of men who tested positive reported recent STI testing. All associations were p < 0.05. Importantly, 60% of infections in men and 28.6% of infections in women would have been missed if only genital testing was performed.
Conclusions: Rates of STI in this sample far exceed national prevalence rates and rates among other high-risk populations such as adolescents and MSM. While an expanded sample is needed to confirm findings, data suggest PWID are a population warranting targeted STI control services and that expanded testing is a necessary to find all cases. Further, co-locating STI control at syringe exchanges could increase case finding and identify PWID with highest HIV risk.