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CDC guidelines on STI testing for PrEP patients may miss cases

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BOSTON — CDC guidelines regarding testing for sexually transmitted infections among patients assigned pre-exposure prophylaxis may need revision after researchers showed that following them would have missed a significant number of asymptomatic cases.

“The reason that this is so important right now is that … PrEP implementation is exploding in the U.S.; it’s expanding very rapidly,” Sarit A. Golub, PhD, MPH, of Hunter College and the Graduate Center at City University of New York, said during a press event at CROI 2016. “We need these guidelines now because it is much harder to tell providers to change their practice once they’ve already started it than it is to get them to start with the practice that we like to see.”

Sarit A. Golub

Golub and colleagues studied 280 patients who began PrEP in SPARK, a community-based PrEP demonstration project affiliated with Callen-Lorde Community Health Center in New York. The patients were screened every 3 months for STIs or during visits between screenings if they were symptomatic. This practice was a departure from CDC guidelines that call for screening every 6 months unless patients report symptoms.

At 3 months, 77% of the patients who had an STI were diagnosed during a routine screening that would not have been performed under CDC guidelines, the investigators reported, rather than a symptomatic presentation. In addition, Golub and colleagues noted, only 33% of the patients with an STI at their 3-month follow-up visit had a prior history of STI that would have warranted screening. Further, 68% of the patients with an STI at 9 months were diagnosed during routine screening rather than a symptomatic presentation that would have been necessary to trigger testing at 9 months under CDC guidelines.

“Even though the percentage of patients with repeat STI diagnoses increased over time, basing STI screening on prior diagnosis at the 9-month visit would have missed 16% of STI cases,” Golub and colleagues wrote. “Overall, STI screening according to current CDC guidelines would have delayed diagnosis and treatment for 24% of PrEP patients, including 40 cases of rectal STI and three cases of syphilis.”

Golub said there is “tremendous potential” for a long-term reduction in STI prevalence because of the potential of PrEP to identify more cases. Further reduction can be achieved through contact tracing, she said.

“We are getting PrEP to the people who need it most, to folks who are consistently vulnerable to infection, but I want to stress that because of that, testing and treatment is critical, both for PrEP patients themselves and for their partners.” – by Gerard Gallagher

Reference:

Golub SA, et al. Abstract 869. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.

Disclosure: Golub reports that Gilead Sciences provided the study drug for the SPARK PrEP Demonstration Project, but had no role in data analysis or interpretation.