Chlamydia and Gonorrhea Testing Remains Suboptimal Among MSM with HIV

In the United States, research has shown that the incidence of sexually transmitted diseases (STD) has consistently risen for the general population. Cases of chlamydia and gonorrhea, in particular, are increasing, but there is limited data on testing rates and incidence among the estimated 1.1 million people in the United States living with HIV.

A new study in Clinical Infectious Diseases examined incidence, testing rates, and associated risk factors among people living with HIV, including by anatomic site among men who have sex with men (MSM). Investigators found that recent chlamydia and gonorrhea incidence and testing had increased among people living with HIV, but that only half of MSM had been tested during 2016-2017 with less than one-third of tests being 3-site.

Study authors obtained their findings by analyzing 2007-2017 medical records from HIV outpatient study participants at 9 HIV clinics across the country. Clinics were located in Illinois, Colorado, New York, Pennsylvania, Florida, and Washington DC. The analysis timeframe spanned from January 1, 2007 through September 30, 2017.

Of 10,878 HIV outpatient study participants who consented to participate, there were 9029 seen at the 9 sites, and 4895 met the enrollment requirement of having had at least 2 visits on site and 1 visit in the observation window, and 4727 had at least 1 CD4 and VL test recorded.

Among the 4727 eligible participants, 397 had 881 chlamydia infections with an overall incidence of 2.95 per 100 person-years. Gonorrhea infections were recorded in 331 participants with 861 infections, with an overall incidence of 2.88 per 100 person-years. Laboratory confirmation was available for 449 of 881 chlamydia infections, thus 432 were based on charted diagnosis or treatment. A similar 413 of 861 gonorrhea infections were laboratory confirmed, with 448 based on charted diagnosis or treatment.

The median age among participants was 43 years, 44.8% of participants were non-Hispanic/Latino white ethnicity, 34.5% were non-Hispanic/Latino black, 13% were Hispanic/Latino, and 3.8% were of other race/ethnicity. MSM made up 58.4% of the study population, heterosexual females made up 17.4%, and 10.5% of participants were heterosexual males.

Multivariable factors associated with incidence included MSM status, younger age, and prior diagnoses of sexually transmitted diseases.

Over the observation period, testing rates steadily increased across the 9 HIV outpatient clinics. Study authors speculated that the coincident increases in testing and incidence rates over time suggests that changing testing practices and improved screening in MSM might contribute to the observed increases in chlamydia and gonorrhea. Despite the increase in testing, study authors wrote that testing rates remained suboptimal among people living with HIV who are MSM.

US Centers for Disease Control and Prevention guidelines recommend that sexually active MSM undergo testing based on self-reported sites of sexual contact, but investigators noted that participants who underwent 3-site testing (urethra, rectum, and pharynx) had higher rates of any positive result than those who underwent 2-site and urethral testing.

Study authors concluded that the suboptimal testing rates they observed in MSM indicate potential missed opportunities for STD identification and treatment, impeding HIV and other STD prevention. They wrote that additional study would be beneficial to further assess benefits of routine chlamydia and gonorrhea 3-site testing.