Gonorrhea and Chlamydia Testing in Routine Clinical Care of HIV-Infected Men Who Have Sex with Men
Men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmitted diseases (STDs) including Neisseria gonorrhoeae (GC) and Chlamydia trachomatis(CT). Centers for Disease Control and Prevention STD Treatment Guidelines recommend screening sexually active MSM annually for urogenital and extragenital GC/CT, depending upon sites of exposure. Data on rates, correlates, and results of GC/CT testing among HIV+ MSM in routine HIV clinical care are limited.
A cross-sectional study at a university-based HIV clinic evaluated GC/CT testing among established patients in 2012, with primary focus on MSM. Patients were included if ≥19 years old, in care for >1 year, with at least 2 visits ≥90 days apart within the last year.
Of 1,523 eligible patients (mean age 46 yrs; 59% MSM, 18% heterosexual men, 23% women; 53% African-American), 632 (41%) received GC/CT testing within the prior year. Testing was more prevalent among women than heterosexual men or MSM (67% vs. 32% vs. 35%). Among MSM (n=890), 307 received GC/CT testing of which urogenital GC/CT testing was done in 32%, rectal in 9% and pharyngeal in 3%. Overall 15 patients tested positive for GC and 16 for CT; most were MSM (14/15 and 13/16 respectively). Among MSM receiving rectal testing (n=77), 12% were GC and 16% CT positive. Of 9 positive rectal tests for GC in MSM, urogenital testing was also done in 6 [positive=1]. Of 12 positive rectal tests for CT in MSM, urogenital testing was also done in 9 [positive=2]. In multivariable analysis, factors significantly associated with increased GC/CT testing among MSM included African-American race (prevalence ratio, PR 1.30; 95% CI: 1.08-1.55) and self-reported sex without condom use (PR1.36; 95% CI: 1.07-1.73), while age (PR 0.93 per 5 yr increase; 95% CI 0.89-0.97) and STD history (PR 0.81; 95% CI 0.69-0.97) were significantly associated with decreased testing.
Prevalence of GC/CT testing among MSM in routine HIV care was low, particularly extragenital testing. Most positive GC/CT results were from rectal testing in MSM, and corresponding urogenital tests were usually negative. Increased rectal GC/CT testing among HIV+ MSM would likely capture a significant number of undiagnosed GC and CT infections.
C. M. Tong,
A. Tamhane, None
E. Hook III, None
N. Van Wagoner, None
J. Dionne-Odom, None
J. Raper, None
G. A. Burkholder, None