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.; Weiss, Kevin M; Prasad, Pragati; Zlotorzynska, María; Sanchez, Travis

doi:10.1097/olq.0000000000000896

Cited by 12 publications

(13 citation statements)

References 30 publications

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“…This demonstrates the value of targeted screening compared with population-level screening, similar to findings surrounding the importance of focusing on a core group for prevention of disease transmission [30]. In the model, as infections decreased, fewer than 10% of testing events were symptoms-driven, consistent with empirical data from MSM [22]. It is important to note that previous analyses have shown that if there were an influx of new STI cases into the MSM population, potentially imported from other areas or from bridging with heterosexual populations, reduced screening levels could lead to a rebound in infections [15].…”

Section: Discussionsupporting

confidence: 74%

“…These data sources do not separate symptoms-based testing and routine, asymptomatic screening. Model-calibrated values reflect a mixture of symptoms-based testing and asymptomatic screening, with the observed split similar to other empirical data, where <10% of testing events were symptoms-driven [22]. Reference models assumed only annual screening (0% HR coverage), given the lack of nationally representative data on screening frequency; a recent analysis suggested minimal associations of risk behavior and screening interval, where HIV-negative MSM screened, on average, less than annually [22].…”

Section: Methodssupporting

confidence: 68%

“…A recent venue-based study estimated that 1 in 8 MSM had prevalent extragenital NG or CT infection and one-third reported not having been tested for STIs in the past 12 months, suggesting that high-risk MSM were not being screened per CDC recommendations [10]. Behavioral risk is estimated to have little impact on STI screening frequency, with the screening rate increasing only 1.4% per additional anal sex partner in 1 national study [22]. The sensitivity of our current model to screening frequency provides further evidence that high-risk MSM are not screening frequently.…”

Section: Discussionmentioning

confidence: 99%

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Optimizing Coverage vs Frequency for Sexually Transmitted Infection Screening of Men Who Have Sex With Men

Weiss

Jones

Anderson

et al. 2019

Open Forum Infectious Diseases

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Background The incidence of bacterial sexually transmitted infections (STIs) in men who have sex with men (MSM) has increased substantially despite availability of effective antibiotics. The US Centers for Disease Control and Prevention (CDC) recommends annual screening for all sexually active (SA) MSM and more frequent screening for high-risk (HR) MSM. The population-level benefits of improved coverage vs increased frequency of STI screening among SA vs HR MSM are unknown. Methods We used a network transmission model of gonorrhea (NG) and chlamydia (CT) among MSM to simulate the implementation of STI screening across different scenarios, starting with the CDC guidelines at current coverage levels. Counterfactual model scenarios varied screening coverage and frequency for SA MSM and HR MSM (MSM with multiple recent partners). We estimated infections averted and the number needed to screen to prevent 1 new infection. Results Compared with current recommendations, increasing the frequency of screening to biannually for all SA MSM and adding some HR screening could avert 72% of NG and 78% of CT infections over 10 years. Biannual screening of 30% of HR MSM at empirical coverage levels for annual SA screening could avert 76% of NG and 84% of CT infections. Other scenarios, including higher coverage among SA MSM and increasing frequency for HR MSM, averted fewer infections but did so at a lower number needed to screen. Conclusions The optimal screening scenarios in this model to reduce STI incidence among MSM included more frequent screening for all sexually active MSM and higher coverage of screening for HR men with multiple partners.

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Section: Discussionsupporting

confidence: 74%

Section: Methodssupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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Optimizing Coverage vs Frequency for Sexually Transmitted Infection Screening of Men Who Have Sex With Men

Weiss

Jones

Anderson

et al. 2019

Open Forum Infectious Diseases

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“…Infrequent extragenital screening is a public health concern because of the higher prevalence of asymptomatic chlamydia or gonorrhea infections that may remain undetected [30]. Asymptomatic STIs at these sites also lead to increased risk of HIV infection among partners in the sexual network not using PrEP [23,31].…”

Section: Discussionmentioning

confidence: 99%

“…ARTnet eligibility criteria included male sex at birth, current male identity, lifetime history of sexual activity with another man, and age between 15 and 65 years. The study, provided only in English, surveyed participants about recent sexual behaviors, HIV and STI screening, and egocentric network data [24]. We restricted the participants in this analysis to PrEP-eligible MSM, defined as MSM who had ever had an HIV test and who self-reported as HIV-negative.…”

Section: Methodsmentioning

confidence: 99%

Gaps in Sexually Transmitted Infection Screening among Men who Have Sex with Men in PrEP Care in the United States

Chandra

Weiss

Kelley

et al. 2020

Preprint

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241 [250 max] Text: 2975 [3000 max] References: 40 [40 max] KEYWORDS HIV; preexposure prophylaxis; sexually transmitted infections; screening; men who have sex with men SUMMARY Nearly half of U.S. men who have sex with men in PrEP care are not receiving consistent bacterial STI screening at sites of sexual exposure, and levels are worse in the Southeast region where the burden of STI is highest.ABSTRACT Background The U.S. Centers for Disease Control and Prevention (CDC) recommends comprehensive sexually transmitted infection (STI) screening every 3-6 months for men who have sex with men (MSM) using HIV preexposure prophylaxis (PrEP). The gaps between these recommendations and clinical practice by region have not been quantified. MethodsWe collected data between 2017 and 2019 on STI screening among MSM across the U.S., stratified by current, prior, and never PrEP use. Poisson regression models with robust error variance were used to model factors, including residence in the Southeast states, associated with consistent exposure site-specific STI screening during PrEP care. ResultsOf 3259 HIV-negative MSM, 19% were currently using PrEP, 6% had used PrEP in the past, and 75% had never used PrEP. Among ever PrEP users, 87%, 78%, 57%, and 64% reported consistent screening for STIs by blood sample, urine sample or urethral swab, rectal swab, or pharyngeal swab, respectively, during PrEP care. Compared to PrEP users in all other regions, PrEP users in the Southeast were significantly less likely to be consistently screened for urogenital [adjusted prevalence ratio (aPR): 0.86, 95% confidence interval (CI): 0.76, 0.98] and rectal STIs (aPR: 0.76, 95% CI: 0.62, 0.93) during PrEP care.Conclusions Substantial gaps exist between CDC recommendations for STI screening during PrEP care and current clinical practice, particularly for rectal and pharyngeal exposure sites that can harbor asymptomatic infections and for MSM in Southeast states where the STI burden is substantial.

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Risk and demographic factors associated with STI testing adherence among non-single men who have sex with men (MSM) in the United States

Dai,

Xia,

Calabrese

et al. 2024

J Behav Med

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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

Abstract: Self-reported rates of STI screening were close to CDC'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.

Cited by 12 publications

References 30 publications

Optimizing Coverage vs Frequency for Sexually Transmitted Infection Screening of Men Who Have Sex With Men

Optimizing Coverage vs Frequency for Sexually Transmitted Infection Screening of Men Who Have Sex With Men

Gaps in Sexually Transmitted Infection Screening among Men who Have Sex with Men in PrEP Care in the United States

Risk and demographic factors associated with STI testing adherence among non-single men who have sex with men (MSM) in the United States

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