ATLANTA – Extragenital chlamydia and gonorrhea infections are common among men who have sex with men, but screening for extragenital infection is far less common than urethral testing, according to a study of clinic patients.
The lack of extragenital testing likely resulted in a substantial number of missed infections in the clinic population, Roberta Scheinmann of Public Health Solutions, New York, reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
The prevalence of urethral testing among 300 HIV-positive men evaluated at a federally qualified health center in 2011 was 71%, compared with 47% for rectal testing and 40% for pharyngeal testing. Just over a third of the men were tested at all three sites.
Overall, 9% of patients tested positive for chlamydia at any anatomic site, and 9% tested positive for gonorrhea at any anatomic site. Among those who had a rectal test, 14% and 9% were positive for chlamydia and gonorrhea, respectively, Ms. Scheinmann said.
Of the chlamydia cases, about half were rectal. Of the gonorrhea cases 35% were rectal and 23% were pharyngeal.
Based on these findings and the testing rates in this study, an estimated 143 extragenital gonorrhea infections were missed in the clinic population during the study year, and an estimated 223 extragenital chlamydia infections were missed, Ms. Scheinmann said.
Patients were selected randomly from among about 3,000 HIV-positive men who have sex with men who were seen at least once at the center during 2011, and demographic data and data regarding anatomic sites of testing in the year prior to the visit were abstracted from medical records. The patients had a median age of 39 years, more than half were aged 40 or older, 40% were on Medicaid, and about a third were part of the AIDS Drug Assistance Programs.
The median number of medical visits during the study period was six, so the patients "were quite connected to care," she said.
The rates of coinfection among HIV-positive men who have sex with men is high, and the findings of this study are consistent with those from prior studies showing low rates of extragenital testing and high rates of missed infection in this population. In one study, HIV-positive men were rectally screened only 2%-9% of the time, and in another, half of all chlamydia cases and about two-thirds of gonorrhea cases were missed, Ms. Scheinmann said.
Further evaluation to identify potential barriers to screening and missed opportunities for screening is currently underway, as is an effort to improve screening rates, she said.
Ms. Scheinmann reported having no relevant financial disclosures.