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Urine Screening Alone Misses Most Chlamydia and Gonorrhea in HIV+ MSM
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IDSA/IDWeek 2015, October 7-11, San Diego
Mark Mascolini
Prevalence of chlamydia and gonorrhea proved 18 and 17 times higher in HIV-positive men who have sex with men (MSM) in Nebraska than in the general population [1]. All gonorrhea cases and 75% of chlamydia cases would have been missed if only urine screening had been done.
Annual chlamydia and gonorrhea screening is recommended for sexually active MSM, but University of Nebraska researchers who conducted this study observed that extragenital sites really get tested and most extragenital cases remain asymptomatic. As a result, many cases can go untreated. Their study aimed to determine rates of asymptomatic gonorrhea and chlamydia at three anatomical sites in HIV-positive MSM.
The study included men at least 19 years old who had HIV infection and reported sex with other men. Participants had no gonorrhea or chlamydia symptoms at the time of their clinic visit and had received no treatment for these sexually transmitted infections (STIs) or antibiotics active against them in the past 3 weeks. The researchers collected basic demographic and clinical data, and men completed a survey about sexual history and substance use.
Of 151 participants, 149 provided urine, throat, and rectal samples. The group averaged 40.9 years in age, 60% were white, 22% black, and 18% Hispanic. Eight of 90 whites (9%), 5 of 32 blacks (16%), and 5 of 27 Hispanics (19%) had chlamydia or gonorrhea. Participants averaged 3 sex partners in the last year, with no difference between men positive and negative for the 2 STIs. But those who tested positive for chlamydia or gonorrhea were more likely to have receptive anal intercourse in the past year (P = 0.02), report use of cocaine (P = 0.05) or methamphetamine (P = 0.004) in the past 6 months, and have a positive syphilis test (54% versus 32%, not significant at P = 0.2).
Overall chlamydia or gonorrhea rates was 12.1% at the three anatomical sites; 14 men had only extragenital infection, 2 had urine and extragenital infection, and 2 had only positive urine tests. The 2.7% gonorrhea rate was 17 times higher than the general-population rate in the Omaha region, and the 10.7% chlamydia rate was 18 times higher.
Detecting chlamydia or gonorrhea proved almost 4 times more likely when testing extragenital sites than when testing only urine (incidence rate ratio 3.67, 95% confidence interval 1.26 to 10.7). Testing only urine samples would have missed all gonorrhea infections and 75% of chlamydia infections.
The University of Nebraska team concluded that STI rates are "dramatically higher" in MSM with HIV than in the general population. They proposed that STI testing targeting both genital and extragenital sites should be routine because only urine screening "will miss a large number of asymptomatic infections."
Reference
1. Sandkovsky U, O'Neill J, Sayles H, et al. High rates of asymptomatic chlamydia and gonorrhea infection among HIV infected MSM. IDWeek 2015, October 7-11, San Diego. Abstract 120. https://idsa.confex.com/idsa/2015/webprogram/Paper50444.html
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