Background: The IDSA and CDC guidelines recommend annual urine testing for Gonorrhea and Chlamydia (GC/CT) for HIV-infected individuals, with the addition of rectal and pharyngeal screening based on report of sexual practice. We explored GC/CT positivity rates by body site and reason for testing in an urban HIV clinic population.
Methods: Using warehoused data, we retrieved all GC/CT tests for HIV-infected males at Denver Health from May 2012 through April 2015. During chart review, tests with documented symptoms suggestive of GC/CT infection were considered diagnostic and tests without documented symptoms were considered screening tests. Tests with inaccessible medical records were excluded. Associations between test results, presence or absence of symptoms and anatomical test sites were analyzed with chi square tests.
Results: During the three year period, 5755 tests were reviewed; 19% diagnostic, 81% screening. Overall, 5% of tests were positive for GC or CT. Of the diagnostic tests, 10% were positive vs 3% of screening tests (p<0.001). Of all tests, 9% were from pharyngeal sites, 26% rectal, and 65% urine. Rectal tests were positive more often than pharyngeal or urine tests (10% vs 5% and 3%, p<0.001). Combined GC/CT positivity rates were highest for diagnostic rectal (16%) and urine tests (10%) and screening rectal tests (9%). In the absence of symptoms, the most prevalent infection was rectal CT (12%) followed by pharyngeal GC (6%) and rectal GC (5%). Figure 1. Genito-urinary symptoms were more often associated with infection in any site compared to pharyngeal or rectal symptoms (12% vs 5% and 10%, p=0.115). Rectal tests were positive more often than other anatomic sites regardless of symptom reported. Figure 2.
Conclusion: Positivity rates for GC/CT infections varied significantly by anatomical site and presence of symptoms. Although only 3% of all screening tests were positive, 12% of rectal CT screening tests were positive. Among diagnostic tests, rates of rectal GC/CT infection (16%) were higher than tests from other anatomical sites and the location of symptoms was often different from the site of infection. Our results support national GC/CT screening guidelines for HIV-infected men and emphasize the importance of routine testing of all three anatomic sites regardless of reported symptoms.
J. Blum, None
S. Vaughn, None
S. Rowan, None