STD screening of HIV-infected MSM in HIV clinics.
BACKGROUND
National guidelines for the care of human immunodeficiency virus (HIV)-infected persons recommend asymptomatic routine screening for sexually transmitted diseases (STDs). Our objective was to determine whether providers who care for HIV-infected men who have sex with men (MSM) followed these guidelines.


METHODS
We abstracted medical records to evaluate STD screening at 8 large HIV clinics in 6 US cities. We 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. Urethral testing included nucleic acid amplification tests of both urethral swabs and urine. We also calculated the positivity of syphilis, chlamydia, and gonorrhea among screened men.


RESULTS
Medical records were abstracted for 1334 HIV-infected MSM who made 14,659 visits from 2004-2006. The annual screening rate for syphilis ranged from 66.0% to 75.8% during 2004-2006. Rectal chlamydia and rectal and pharyngeal gonorrhea annual screening rates ranged from 2.3% to 8.5% despite moderate to high positivity among specimens from asymptomatic patients (3.0%-9.8%) during this period. Annual urethral chlamydia and gonorrhea screening rates were higher than rates for nonurethral sites, but were suboptimal, and ranged from 13.8% to 18.3%.


CONCLUSIONS
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 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.
Hoover
Karen W
KW
Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. khoover@cdc.gov
Butler
Mary
M
Workowski
Kimberly
K
Carpio
Felix
F
Follansbee
Stephen
S
Gratzer
Beau
B
Hare
Brad
B
Johnston
Barbara
B
Theodore
John L
JL
Wohlfeiler
Michael
M
Tao
Guoyu
G
Brooks
John T
JT
Chorba
Terence
T
Irwin
Kathleen
K
Kent
Charlotte K
CK
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D002690:Chlamydia Infections / Q000175:diagnosis; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology; D019983:Guideline Adherence; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008499:Medical Records; D008875:Middle Aged; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000209:etiology; D013587:Syphilis / Q000175:diagnosis; D014481:United States / Q000453:epidemiology; D055815:Young Adult