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STD Screening of HIV-Infected MSM in HIV Clinics

Hoover, Karen W. MD, MPH*; Butler, Mary PHD; Workowski, Kimberly MD*‡; Carpio, Felix MD, MPH§; Follansbee, Stephen MD; Gratzer, Beau MPP∥**; Hare, Brad MD††; Johnston, Barbara MD‡‡; Theodore, John L. PhD‡‡; Wohlfeiler, Michael MD, JD§§; Tao, Guoyu PhD*; Brooks, John T. MD*; Chorba, Terence MD, MPA*; Irwin, Kathleen MD, MPH*; Kent, Charlotte K. PhD*Evaluation Group for Adherence to STD and Hepatitis Screening

doi: 10.1097/OLQ.0b013e3181e50058
Original Study

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.

This evaluation of sexually transmitted diseases screening of human immunodeficiency virus-infected men who have sex with men in US human immunodeficiency virus clinics found adequate syphilis screening but suboptimal chlamydia and gonorrhea screening despite moderate to high prevalence of these sexually transmitted diseases.

From the *Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †Battelle Centers for Public Health Research and Evaluation, Seattle, WA; ‡Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA; §AltaMed HIV Services, Los Angeles, CA; ¶Kaiser Permanente, San Francisco, CA; ∥HIV/STD Prevention, Howard Brown Health Center, Chicago, IL; **Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL; ††San Francisco General Hospital Medical Center, San Francisco, CA; ‡‡St. Vincent Catholic Medical Centers, New York, NY; and §§Wohlfeiler, Piperato, and Associates, Miami, FL

The following are the members of the Evaluation Group for Adherence to STD and Hepatitis Screening: Mary Butler, Felix Carpio, Terence Chorba, Lauren Christiansen-Lindquist, John Cummins, Stephen Follansbee, Beau Gratzer, Brad Hare, Brenda Hernandez, Karen Hoover, Kathleen Irwin, Nidhi Jain, Barbara Johnston, Charlotte Kent, Clarissa Ospina Norvell, Guoyu Tao, John Theodore, Michael Wohlfeiler, and Kim Workowski.

Correspondence: Karen W. Hoover, MD, MPH, Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE MS E-80, Atlanta, GA 30333. E-mail:

Received for publication January 27, 2010, and accepted April 26, 2010.

© Copyright 2010 American Sexually Transmitted Diseases Association