P3.111 Optimising STI screening in hiv-infected men who have sex with men (MSM)

Abstract

IntroductionCurrent CDC guidelines recommend screening “at least annually” for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) at sites of exposure using nucleic acid amplification tests (NAAT) in HIV-infected MSM. National screening rates remain suboptimal in this high-risk population, particularly at extra-genital sites.MethodsWe enrolled HIV-infected MSM from a routine care visit at the 1917 HIV clinic in Birmingham, Alabama. Inclusion criteria included age >18, receptive anal intercourse in the past 30 days and lack of antibiotic exposure. Participants provided four self-collected rectal swabs and a urine sample. A pharyngeal sample was provider-collected. Samples from the rectal and genital sites were run on four testing platforms with the composite infection standard (≥2 NAAT positive) defining a positive result. Pharyngeal samples were run on two platforms and the patient infection standard (2 NAAT positive) was used to define positivity.ResultsA total of 175 unique HIV-infected MSM were enrolled between December 2014 and November 2016. Overall, 34 men (19.4%) had CT or GC infection detected. CT infection rates by site were: 13.1% rectal, 3.4% urogenital, 0% pharyngeal. GC infection rates by site were: 8.6% rectal, 3.4% urogenital and 2.3% pharyngeal. In addition, 5.7% of men had co-infection with CT and GC at the rectal site and 1.7% had simultaneous CT or GC infection at genital and rectal sites. Most infections (79.4%) would have been missed by genital screening alone.ConclusionSexually active, HIV-infected MSM in Birmingham, Alabama have high prevalence rates of CT and GC infection, particularly at the rectal site. This has public health implications since CT/GC coinfection may increase HIV transmission rates. Clinics that provide care for HIV-infected MSM should streamline extragenital testing; this may include the incorporation of patient-collected rectal swabs into routine care.