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Bacterial Sexually Transmitted Infection Screening Rates by Symptomatic Status Among Men Who Have Sex With Men in the United States

A Hierarchical Bayesian Analysis

Jenness, Samuel M. PhD; Weiss, Kevin M. MPH; Prasad, Pragati BS; Zlotorzynska, Maria PhD, MPH; Sanchez, Travis DVM, MPH

Sexually Transmitted Diseases: January 2019 - Volume 46 - Issue 1 - p 25–30
doi: 10.1097/OLQ.0000000000000896
Original Studies

Background Prevention of bacterial sexually transmitted infections (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 Centers for Disease Control and Prevention STI screening guidelines.

Methods In a cross-sectional study of 2572 US MSM aged 15 to 65 years in 2017 to 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 Human immunodeficiency virus (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). The HIV-uninfected MSM had 0.14 (95% credible interval [CrI], 0.12–0.17) symptomatic tests and 0.88 (95% CrI, 0.77–1.01) asymptomatic screens per year. The 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 with 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% to 90% of diagnostic events were asymptomatic screens.

Conclusions Self-reported rates of STI screening were close to Centers for Disease Control and Prevention'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.

Rates of asymptomatic sexually transmitted infection screening among men who have sex with men varied substantially by human immunodeficiency virus status and demographics, but not behavioral risk, suggesting targeted screening efforts may be indicated.

From the Department of Epidemiology, Emory University, Atlanta, GA

Conflicts of Interest: None declared.

Sources of Funding: 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.

Correspondence: Emory University, 1520 Clifton Rd, Atlanta, GA 30322. E-mail:

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

© Copyright 2019 American Sexually Transmitted Diseases Association