120. High Rates of Asymptomatic Chlamydia and Gonorrhea Infection Among HIV Infected MSM
Session: Oral Abstract Session: HIV Prevention, Early Diagnosis, STDs
Thursday, October 8, 2015: 11:15 AM
Room: 25--ABC
Background: Screening for Chlamydia (CT) and Gonorrhea (GC) is recommended at least annually for sexually active men who have sex with men (MSM). Although most cases of pharyngeal and rectal GC and CT in MSM are asymptomatic, extragenital sites are not frequently screened. The study aim was to determine asymptomatic rates of GC and CT infection at 3 anatomical sites in HIV-infected MSM and compare rates when urine only vs. extragenital sites were tested.

Methods: HIV-infected MSM > 19 yo, asymptomatic for STD, without treatment for GC or CT or antimicrobial use in the last 3 weeks were eligible. Screening for GC and CT in urine, rectum and oropharynx was done during regular clinic appointments. We determined rates for combined GC/CT and compared the proportion of infections detected by testing urine vs extragenital sites. We recorded basic demographics, most recent syphilis serology, CD4 count, viral load and antiretroviral therapy status. Participants completed a sexual history survey to obtain data on sexual behavior, substance abuse and risk factors associated with GC and CT. Samples were analyzed using nucleic acid amplification tests.

Results: Of 151 participants, 149 provided samples from urine, throat and rectum. Mean age = 40.9 yo, 90 White, 32 Black, 27 Hispanic. 18 participants had positive tests from at least one site. 14 had extragenital infections (oral, rectum or both), 2 positive only in urine and 2 positive in urine and extragenital sites. Those who tested positive for CT or GC were more likely to have received anal sex in the previous year, and use cocaine or methamphetamine in the previous 6 months but there were no differences in condom use or number of partners. Overall CT and GC rates were 18 and 17 times greater than those for Omaha. Combined incidence rate (IR) of CT/GC was 12.1% testing 3 sites. The IR was 11% when testing extragenital and 3% for urine only. Finding GC/CT was 3.67 times as likely when testing extragenital sites (IRR 3.67, 95% CI 1.26,10.7). All GC and 75% of CT infections would have been missed and not treated had only urine screening been performed.

Conclusion: The high rates of asymptomatic GC and CT infection in our population underscore the need to offer routine screening for high risk groups such as HIV-infected MSM.  Screening with only a urine sample is more convenient, but will miss a large number of asymptomatic infections.

Uriel Sandkovsky, MD, MS, FACP1, Jennifer O'neill, RN2, Harlan Sayles, MS3, Sara Bares, MD1, Rachelle Carr, MA4, Theresa Tonozzi, MPH5, Patrick Passarelli, MD4, Elizabeth Berthold, MS6 and Susan Swindells, MBBS7, (1)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (2)Medicine, University of Nebraska Medical Center, Omaha, NE, (3)College of Public Health, University of Nebraska Medical Center, Omaha, NE, (4)University of Nebraska Medical Center, Omaha, NE, (5)CDC, Atlanta, GA, (6)Douglas County Health Department, Omaha, NE, (7)Univ. of Nebraska Med. Ctr., Omaha, NE


U. Sandkovsky, None

J. O'neill, None

H. Sayles, None

S. Bares, None

R. Carr, None

T. Tonozzi, None

P. Passarelli, None

E. Berthold, None

S. Swindells, None

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