Because bacterial sexually transmitted diseases (STDs) facilitate HIV transmission, screening for and treatment of STDs among HIV-infected persons should prevent HIV spread to partners. Before screening programs for gonorrhea and Chlamydia infection should be widely established in HIV clinics, it is useful to know the prevalence of these infections. This study analyzed the results of a urine-based screening program for gonorrhea and Chlamydia in a New Orleans HIV clinic and compared the positivity rates to the prevalence in the local community. Among persons screened in the HIV clinic, 1.7% (46/2629) had gonorrhea and 2.1% (56/2629) had Chlamydia infection. Among persons aged 18-29 years, the test positivity for gonorrhea was similar in the HIV clinic to that of persons in sociodemographically similar community samples (3.1 versus 2.4%, adjusted odds ratio 1.6, P = 0.11) and the test positivity for Chlamydia infection was lower (5.4% versus 10.5%, adjusted odds ratio 0.6, P < 0.01). Based on a previously published mathematical model, it was estimated that treatment of all 46 gonorrhea and 56 Chlamydia infections in the HIV clinic may have averted 9 HIV infections among sex partners and saved far more in future medical costs than the cost of the screening. Routine screening for gonorrhea and Chlamydia infection should be considered in HIV clinics.
The United States' response to the AIDS epidemic emphasizes identification, referral, and treatment of HIV-infected persons. 1 However, studies in HIV-infected women, drug users, and men who have sex with men and women have consistently found that many HIV-infected persons continue to be sexually active after diagnosis and during treatment. 2-6 Based on models showing that small reductions in sexual risk-taking in HIV-positive persons should be far more effective in preventing transmission than large reductions in HIV-negative persons, several authors have recommended that HIV prevention programs should emphasize counseling to HIV-infected persons who continue to practice unprotected sex. 7-9 Identification of these persons is therefore needed.
Sexually transmitted diseases (STDs) facilitate the spread of HIV infection. 10,11 Thus diagnosis and treatment of curable STDs in HIV-infected persons can help prevent the spread of HIV infection to partners, even when infected persons continue unprotected sex. Because STDs are frequently asymptomatic, screening is needed to diagnose infections. Screening HIV-infected persons for STDs has the additional advantage that it identifies HIV-infected persons continuing to practice high-risk sexual behavior.
The Centers for Disease Control and Prevention (CDC) recommends STD screening among HIV-positive patients as part of and at the site of routine, quality HIV care,11 but such screening is not widely practiced in HIV clinics in the United States. We examined the potential benefits of an STD screening program in a public HIV clinic in New Orleans. Specifically, we calculated the percentage of HIV-infected patients tested for gonorrhea and Chlamydia infection and compared these results to the screening results of samples of the general local population. To project the potential value of this screening, we made estimates of the number of potential HIV infections among sex partners that were prevented by the treatment of these gonorrhea and Chlamydia infections.