961. Triple-dip:  Expanded extra-genital testing for Neisseria gonorrhoeae and Chlamydia trachomatis identifies high rates of asymptomatic infection in persons living with HIV
Session: Poster Abstract Session: Sexually Transmitted Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C

US guidelines now call for expanded extra-genital testing for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (Ct) in HIV infected individuals. In January 2012, we instituted a new policy to promote routine three-site testing (genital, oropharyngeal, rectal) for GC/Ct among HIV-infected persons in our clinic population. The purpose of this study is to assess implementation of the “triple-dip” program, as well as the prevalence and incidence of STI at each site.


We conducted a retrospective chart review of HIV-infected patients seen in our clinic before (Jan.-Dec. 2011) and after (Jan.-Dec. 2012) implementation of a routine three-site testing policy, to compare GC/Ct prevalence during these two time periods.  Self-reported behavioral data were also evaluated.


A total of 1581 HIV patients received GC/CT testing between 2011 and 2012.  The number of patients receiving triple screens increased from 22 in 2011 to 362 in 2012, a 16 fold increase (p<0.0001).  Of the total 207 positive tests between 2011 and 2012, 65 cases of rectal disease (31.4%) and 35 cases of oral disease (16.7%) would not have been detected without implementation of advanced screening.  The incidence of rectal disease was significantly higher in 2012 than the incidence of genitourinary disease (8.9% vs. 2.1% for chlamydia, 6.7% vs. 1.7% for gonorrhea, p=<0.0001), and the incidence of oral gonorrhea (5.8%) was significantly higher than the incidence of genitourinary gonorrhea (1.7%) (p<0.0001). Interestingly, while the incidence of chlamydial and gonococcal rectal (8.9 and 6.7) and GU (2.1 and 1.7) infections were similar, the incidence of oropharyngeal gonococcal infection was significantly higher than the rate of oral chlamydial infection (5.8 vs. 1.6, p=0.0003).   


Although extra-genital testing increased with expanded testing, not all patients at risk were screened.   Given the higher percentage positive rectal tests, enhanced testing should focus on increasing awareness of rectal infection, treatment intervention, and risk counseling. 

Michelle Sabo, MD/PhD, Washington University in Saint Louis, Saint Louis, MO, Hilary Reno, MD, PhD, BJC HealthCare, St. Louis, MO, Rachel Presti, MD, Washington University School of Medicine, St Louis, MO and Bradley P. Stoner, MD, PhD, FIDSA, Infectious Diseases, Washington University, St Louis, MO


M. Sabo, None

H. Reno, None

R. Presti, None

B. P. Stoner, None

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