May 9, 2011
The researchers undertook the current study to determine whether providers who care for HIV-positive men who have sex with men (MSM) are following national guidelines that recommend asymptomatic routine STD screening for patients with HIV.
Medical records were abstracted to evaluate STD screening at eight large HIV clinics in six US cities. The team estimated the number of men who had at least one test for syphilis, chlamydia (urethral and/or rectal) or gonorrhea (urethral, rectal, and/or pharyngeal) in 2004, 2005, and 2006. The urethral testing included nucleic acid amplification tests of both urethral swabs and urine. Positivity rates for syphilis, chlamydia, and gonorrhea were calculated.
The analysis included 1,334 HIV-positive MSM who made 14,659 visits from 2004 to 2006. During this time, the annual screening rate for syphilis ranged from 66 percent to 75.8 percent. Annual screening rates for rectal chlamydia and rectal and pharyngeal gonorrhea ranged from 2.3 percent to 8.5 percent, despite moderate to high positivity (3 percent to 9.8 percent) among specimens from asymptomatic patients. Annual urethral chlamydia and gonorrhea screening rates were higher than for nonurethral sites, 13.8 percent to 18.3 percent, but remained suboptimal.
"Most asymptomatic HIV-infected MSM were screened for syphilis, indicating good provider adherence to this screening guideline. Low screening rates for gonorrhea and chlamydia, especially at rectal and pharyngeal sites, suggest that substantial barriers exist for complying with these guidelines," the authors concluded. "The moderate to high prevalence of asymptomatic chlamydial and gonococcal infections underscores the importance of screening. A range of clinical quality improvement interventions are needed to increase screening, including increasing the awareness of nucleic acid amplification tests for nonurethral screening."