title: Increased gonorrhoea and chlamydia testing did not increase case detection in an HIV clinical cohort 1999-2007.
abstract: OBJECTIVE
  Since 2003, US organisations have recommended universal screening, rather than targeted screening, of HIV-infected persons for gonorrhoea and chlamydia. The objective of this study was to determine whether wider testing resulting from these guidelines would produce an increase in gonorrhoea/chlamydia diagnoses.
  
  
  METHODS
  3283 patients receiving HIV care in 1999-2007 in the Johns Hopkins Hospital HIV clinic were studied. The two primary outcomes were the occurrence of any gonorrhoea/chlamydia testing in each year of care and the occurrence of any positive result(s) in years of testing. The proportion of all patients in care who were diagnosed with gonorrhoea/chlamydia was defined as the number of patients with positive results divided by the number of patients in care. Trends were analysed with repeated measures logistic regression.
  
  
  RESULTS
  The proportion of patients tested for gonorrhoea/chlamydia increased steadily from 0.12 in 1999 to 0.33 in 2007 (OR per year for being tested 1.17, 95% CI 1.15 to 1.19). The proportion positive among those tested decreased significantly after 2003 (OR per year 0.67, 95% CI 0.55 to 0.81). The proportion of all patients in care diagnosed with gonorrhoea/chlamydia therefore remained generally stable in 1999-2007 (OR per year 0.97, 95% CI 0.91 to 1.04).
  
  
  CONCLUSIONS
  Universal annual screening, as implemented, did not increase the proportion of all patients in care who were diagnosed with gonorrhoea/chlamydia. Similarly low implementation rates have been reported in cross-sectional studies. If future efforts to enhance implementation do not yield increases in diagnoses, then guidelines focusing on targeted screening of high-risk groups rather than universal screening may be warranted.
authors: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21287-2100, USA. sberry8@jhmi.edu
authors: Stephen A
authors: SA
authors: Berry
authors: Khalil G
authors: KG
authors: Ghanem
authors: Kathleen R
authors: KR
authors: Page
authors: Stephen J
authors: SJ
authors: Gange
authors: Chloe L
authors: CL
authors: Thio
authors: Richard D
authors: RD
authors: Moore
authors: Kelly A
authors: KA
authors: Gebo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001431:Bacteriological Techniques / Q000706:statistics & numerical data; D015142:Baltimore / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D015331:Cohort Studies; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology; D015497:HIV-1; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D055815:Young Adult