SAN DIEGO – Among HIV-infected males, positivity rates for gonorrhea and chlamydia infections varied significantly by anatomical site and presence of symptoms, judging from the results from a large, 3-year analysis.
The findings “suggest a need to consider testing multiple sites regardless of reported symptom, possibly depending on reported sexual practice,” Dr. Sarah Rowan said at an annual scientific meeting on infectious diseases.
Dr. Sarah Rowan
Guidelines from the Infectious Diseases Society of America and the Centers for Disease Control and Prevention recommend annual urine testing for gonorrhea and chlamydia (GC/CT) for HIV-infected individuals, with the addition of rectal and pharyngeal screening based on report of sexual practice. The investigators explored GC/CT positivity rates by body site and reason for testing in an urban HIV clinic population. They evaluated all GC/CT tests for HIV-infected males at Denver Health from May 2012 through April 2015. On chart review, tests with documented symptoms suggesting GC/CT infection were considered diagnostic tests, while tests without documented symptoms were considered screening tests. The researchers excluded tests with inaccessible medical records and used chi square analysis to examine associations between test results, presence or absence of symptoms, and anatomical test sites.
Results were available from 5,755 tests conducted in 1,232 men with a median age of 44 years. The men had an average of 4.67 tests, most of which were screening tests (81%; the remaining 19% were diagnostic). Among all tests, 5% were positive for GC or CT and a significantly higher proportion of diagnostic tests were positive, compared with screening tests (10% vs. 3%, respectively; P less than .001), reported Dr. Rowan, an internist and pediatrician with the Denver Health and Hospital Authority.
By anatomic site, the majority of all tests were urine tests (65%), followed by those obtained from pharyngeal sites (26%), and rectal sites (9%), while rectal tests were positive more often than pharyngeal or urine tests (10% vs. 5% and 3%, respectively; P less than .001). Combined GC/CT positivity rates were highest for diagnostic rectal (16%) and urine tests (10%) and screening rectal tests (9%).
The researchers also observed that in the absence of symptoms, the most prevalent infection was rectal CT (12%), followed by pharyngeal GC (6%) and rectal GC (6%). Genitourinary symptoms were more often associated with infection in any site, compared with pharyngeal or rectal symptoms (12% vs. 5% and 10%, respectively; P = .115), while rectal tests were positive more often than other anatomic sites regardless of symptom reported.
“Although only 3% of all screening tests were positive, 12% of rectal chlamydia screening tests and 6% of pharyngeal and rectal gonorrhea screening tests were positive, suggesting that screening extragenital sites may identify more infections than screening urine,” Dr. Rowan said.
IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.