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Sexually Transmitted Disease Testing of Human Immunodeficiency Virus–Infected Men Who Have Sex With Men: Room for Improvement

Dean, Bonnie B. PhD, MPH*; Scott, Mia DO; Hart, Rachel MS*; Battalora, Linda PhD*‡; Novak, Richard M. MD§; Durham, Marcus D. MS; Brooks, John T. MD; Buchacz, Kate PhDHIV Outpatient Study (HOPS) Investigators

doi: 10.1097/OLQ.0000000000000664
Original Studies

Background In the United States, sexually transmitted infection (STI) testing is recommended at least annually for sexually active men who have sex with men (MSM). We evaluated human immunodeficiency virus (HIV) providers’ STI testing practices and frequency of positive test results.

Methods We analyzed data from HIV Outpatient Study (HOPS) participants who, from 2007 to 2014, completed a confidential survey about risk behaviors. Using medical records data, we assessed the frequency of gonorrhea, chlamydia, and syphilis testing and positive results during the year after the survey for MSM who reported sex without a condom in the prior 6 months. We compared testing frequency and positivity for men having 1, 2 to 3, and 4 or more sexual partners. Correlates of STI testing were assessed using general linear model to derive relative risks (RR) with associated 95% confidence intervals (CI).

Results Among 719 MSM, testing frequency was 74.5%, 74.3%, and 82.9% for gonorrhea, chlamydia, and syphilis, respectively, and was higher in those men who reported more sexual partners (P < 0.001 for all). In multivariable analysis, testing for gonorrhea was significantly more likely among non-Hispanic black versus white men (RR, 1.17; 95% CI, 1.03–1.33), among men seen in private versus public clinics (RR, 1.16; 95% CI, 1.05–1.28), and among men with 2 to 3 and 4 or more sexual partners versus 1 partner (RR, 1.12; 95% CI, 1.02–1.23, and RR, 1.18; 95% CI, 1.08–1.30, respectively). Correlates of chlamydia and syphilis testing were similar. Test positivity was higher among men with more sexual partners: for gonorrhea 0.0%, 3.0%, and 6.7% for men with 1, 2 to 3, and 4 or more partners, respectively (P < 0.001, syphilis 3.7%, 3.8% and 12.5%, P < 0.001).

Conclusions Among HIV-infected MSM patients in HIV care who reported sex without a condom, subsequent testing was not documented in clinic records during the following year for up to a quarter of patients. Exploring why STI testing did not occur may improve patient care.

Among human immunodeficiency virus–infected men who have sex with men in human immunodeficiency virus care who reported sex without a condom, up to 25% did not have documented sexually transmitted infection testing in the following year.

From the *Cerner Corporation, Kansas City, MO; †Apex Family Medicine, Denver; ‡Colorado School of Mines, Golden, CO; §University of Illinois, Chicago, IL; and ¶Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Listed in the Appendix: HIV Outpatient Study (HOPS) Investigators.

Financial support: Centers for Disease Control and Prevention (contract nos. 200-2001-00133, 200-2006-18797, 200-2011-41872, and 200-2015-63931).

Disclaimers: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Conflicts of interest: None declared.

Correspondence: Kate Buchacz, PhD, Epidemiology Branch, Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-45, Atlanta, GA 30333. E-mail:

Received for publication January 30, 2017, and accepted May 15, 2017.

© Copyright 2017 American Sexually Transmitted Diseases Association