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BSTI testing rates low among sexually active HIV population
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Testing rates for bacterial sexually transmitted infections were low among sexually active patients with HIV, particularly those at elevated risk, according to findings from the Medical Monitoring Project.
“Most HIV-infected patients in the United States engaged in sexual activity during the past 12 months; almost half of [men who have sex with men] and almost one quarter of [men who have sex with women only] and women were at elevated sexual risk,” Elaine W. Flagg, PhD, MS, and colleagues from the CDC wrote in Sexually Transmitted Diseases. “However, testing for [bacterial sexually transmitted infection] among HIV-infected patients was low and did not substantially increase for those at elevated risk.”
The Medical Monitoring Project, a complex-sample, cross-sectional survey, collects behavioral and clinical characteristics of adults with HIV receiving medical care in the U.S. Researchers conducted face-to-face interviews with 4,217 patients between June 2009 and May 2010, asking the patients about their sexual activity in the past year.
Flagg and colleagues classified the patients into two risk groups. The elevated sexual risk group included patients who reported having more than one sexual partner or who engaged in illicit drug use before or during sex in the last year. The low-risk group included participants with only one sex partner and no illicit drug use with sex in the past year who also reported consistent condom use. Participants who reported no condom use were classified as being at elevated risk if they considered their sex partner a casual partner, or if their partner was HIV-negative or of unknown HIV status. The researchers used medical records to determine bacterial sexually transmitted infection (BSTI) testing status.
The results show that BSTI testing rates were low. Fifty-five percent of all sexually active patients were tested at least once in the previous year for syphilis, 23% were tested at least once for gonorrhea and 24% for chlamydia, the researchers wrote. They saw significantly higher syphilis testing rates in men who have sex with men (MSM), men who have sex with women only (MSW) and women if they had received at least 3 CD4+ T-lymphocyte cell counts and/or HIV viral load tests in one year. The researchers found that 30% of sexually active women had higher rates of chlamydia testing compared with MSW (19%).
While 46% of MSM in this study were at elevated sexual risk, only 26% received repeat syphilis testing; repeat testing for gonorrhea and chlamydia was only 7%, according to Flagg and colleagues.
“Patient encounters in which [CD4 and viral load] testing is conducted present opportunities for BSTI testing,” the researchers wrote. “Additional interventions, such as alerts and prompts incorporated into electronic medical records, may be effective additions to national guidelines for improving BSTI testing.”
Disclosure: The researchers report no relevant financial disclosures.
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