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Self-Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in the Human Immunodeficiency Virus Clinic—High Yields and High Acceptability

Soni, Suneeta MBChB, MRCP*; White, John A. MBBS, FAChSHM

doi: 10.1097/OLQ.0b013e31822e6136
Original Study

Background: Despite antiretroviral therapy (ART), incident human immunodeficiency virus (HIV) continues to rise, and sexually transmitted infections (STI) are well known for their part in HIV transmission. National guidelines recommend routine STI screening in HIV-positive individuals, but despite this, reported uptake remains low.

Methods: We implemented a nurse-led self-screening program for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in asymptomatic HIV patients. Self-collected samples were tested for CT and GC using the GenProbe Aptima Combo 2 assay. Clinical records were reviewed for ART history, CD4 T-cell count, and plasma viral load. A screening service evaluation questionnaire was handed out.

Results: During an 8-month period, 976 screens were performed. In all, 143 infections were detected which would have been missed without the screening program. Overall prevalence of infection among men who have sex with men was 17.4%: rectal CT and GC, 9.8% (56/571) and 4.2% (24/571), respectively; urethal CT and GC, 2.6% (16/605) and 1.3% (8/605), respectively; and pharyngeal CT and GC, 1.7% (10/589) and 3.9% (23/589), respectively. Among heterosexual men and women, the rates of CT were 2.1% (3/141) and 1.5% (3/201), and there was no GC. Transient viremia was observed at the time of STI diagnosis in 6 patients on ART. All men who have sex with men and most women found self-swabbing acceptable, and most patients indicated that they would like to be offered testing in future.

Conclusion: These findings highlight the need for the introduction of similar screening approaches in HIV clinics. Self-collected specimens using sensitive and specific GC and CT nucleic acid amplification tests are a convenient and acceptable way of testing, and it may address some of the barriers to screening in this population.

Self screening for sexually transmitted infections in human immunodeficiency virus-positive men who have sex with men uncovered high rates of extragenital infection which would otherwise have been missed, and self-swabbing was found to be acceptable and convenient. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

From the *Department of Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; and †Department of Genitourinary Medicine, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom

Correspondence: Suneeta Soni, MBChB, MRCP, Lawson Unit, Royal Sussex County Hospital, Eastern Rd, Brighton BN2 5BE, United Kingdom. E-mail:

Received for publication March 20, 2011, and accepted July 18, 2011.

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© Copyright 2011 American Sexually Transmitted Diseases Association