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Bacterial STI Screening Rates by Symptomatic Status among Men Who Have Sex with Men in the United States: A Hierarchical Bayesian Analysis

Jenness, Samuel M., PhD1; Weiss, Kevin M., MPH1; Prasad, Pragati, BS1; Zlotorzynska, Maria, PhD1; Sanchez, Travis, DVM1

doi: 10.1097/OLQ.0000000000000896
Original Study: PDF Only

Background Prevention of bacterial STIs among men who have sex with men (MSM) requires timely disease detection, but this is complicated by asymptomatic infection. We estimated screening/testing rates by symptomatic status to evaluate adherence to CDC STI screening guidelines.

Methods In a cross-sectional study of 2572 US MSM aged 15–65 in 2017–2018, we measured the reported number of asymptomatic STI screens in the past 2 years versus tests prompted by disease symptoms. Using negative binominal regression within a hierarchical Bayesian framework, we estimated yearly rates of asymptomatic screening and symptomatic testing by geographic, demographic, and behavioral factors.

Results HIV status was most strongly associated with all testing/screening frequency (Incidence Rate Ratio [IRR]=1.72; 95% credible interval [Crl] = 1.49, 1.97). HIV-uninfected MSM had 0.14 (95% CrI = 0.12, 0.17) symptomatic tests and 0.88 (95% CrI = 0.77, 1.01) asymptomatic screens per year. HIV-infected MSM had 0.25 (95% CrI = 0.18, 0.35) symptomatic tests and 1.53 (95% CrI = 1.24, 1.88) asymptomatic screens per year. Rates of asymptomatic screening were higher among black compared to white MSM (IRR = 1.41; 95% CrI = 1.15, 1.73), but weakly associated with number of past-year sexual partners (IRR = 1.01; 95% CrI = 1.00, 1.01). Overall, 85–90% of diagnostic events were asymptomatic screens.

Conclusions Self-reported rates of STI screening were close to CDC’s recommended overall annual screening frequency, but with gaps defined by demographics and behavioral risk. Targeted screening efforts may be indicated specifically for younger MSM and those with multiple partners.

1Department of Epidemiology, Emory University, Atlanta, GA;

Corresponding Author: Samuel M. Jenness, PhD, Emory University, 1520 Clifton Road, Atlanta, GA 30322.


This study was supported by the National Institutes of Health [R21 MH112449], the Center for AIDS Research at Emory [NIH grant: P30 AI050409], and a grant from the MAC AIDS Fund. The authors declare no conflicts of interest.

Received for publication April 11, 2018, and accepted July 15, 2018.

© Copyright 2018 American Sexually Transmitted Diseases Association