Hospitals may not be following CDC guidance on STI screening, study shows
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Key takeaways:
- Less than 3% of patients tested for chlamydia, gonorrhea or syphilis were also tested for HIV in the ED.
- The CDC recommends that anyone being screened for an STI also be screened for HIV.
Less than 3% of patients tested for a bacterial STI in nearly a dozen EDs were also tested for HIV, demonstrating widespread nonadherence to a CDC recommendation, according to a study presented at IDWeek.
“Our concern was that people are coming in to these venues and getting screened based on their chief complaint but not getting a comprehensive STI screen, including an HIV test,” Braden Sciarra, MD, an infectious diseases clinical fellow at the University of Colorado School of Medicine, told Healio.
“We looked at patients that received a gonorrhea, chlamydia or syphilis test in the ED setting and, in that at-risk group, [asked if they were] also being screened for HIV. What we found, unfortunately, was we’re doing a really poor job of that,” Sciarra said.
The CDC recommends that anybody who seeks an STI test who is not known to have HIV should be tested for HIV at the same time as the STI test, but Sciarra noted that ED clinicians are under pressure to treat and release people because of crowded waiting rooms, and that getting patients to come back to the ED for results or treatment can be challenging.
As STIs have surged in the United States in recent years, experts have said it is essential to screen more people to detect more cases.
Sciarra and colleagues performed an analysis of STI screening for gonorrhea, chlamydia and syphilis, as measured by HIV cotesting, at 11 EDs between Jan. 1, 2019, and Dec. 31, 2023.
During the study period, the researchers found that of 10,895 patients screened for any of the three STIs, a comprehensive screening — which includes an HIV test — was completed in an average of just 2.9% of patients per year.
Of the patients screened for one of the three STIs, 2,082 tested positive for either gonorrhea or chlamydia. Among these patients, the average rate of HIV co-testing for the study period was 2.6% per year.
Sciarra said the hospitals implemented new educational tools to help ED clinicians have access to more information about screening and can connect patients to care, as well as make it more routine to screen patients and discuss the results with them — including partnering doctors with ID staff at the hospitals.
“You’re only going to identify HIV in asymptomatic people if you test for it, right?” Sciarra said. “You have to identify at-risk individuals. If people are asking to be screened for gonorrhea, chlamydia or syphilis, or presenting with those symptoms, they’re also at risk for HIV. You should make sure you test folks for those things.”
References:
- Sciarra B, et al. Poster 1375. Presented at: IDWeek; Oct. 16-19, 2024; Los Angeles.
- CDC. Sexually transmitted infections treatment guidelines, 2021: HIV infection: Detection, counseling and referral. https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf. Published July 22, 2021. Accessed Nov. 5, 2024.
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Sciarra B, et al. Poster 1375. Presented at: IDWeek; Oct. 16-19, 2024; Los Angeles.
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