Increased gonorrhoea and chlamydia testing did not increase case detection in an HIV clinical cohort 1999–2007. Issue 6 (11th July 2011)

• Record Type: Journal Article
• Authors: Berry, Stephen A; Ghanem, Khalil G; Page, Kathleen R; Gange, Stephen J; Thio, Chloe L; Moore, Richard D; Gebo, Kelly A
• Is Part Of: Sexually transmitted infections. Volume 87:Issue 6(2011)
• Page Start: 469
• Page End: 475
• Publication Date: 2011-07-11
• Subjects: Antiretroviral thera -- Chlamydia trachomatis -- cost-effectiveness -- guidelines -- health service research -- HIV -- HIV prevention -- infectious diseases -- Neisseria gonorrhoeae -- screening -- STD control -- syphilis serology -- Treponema pallidum -- treponemal infection; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2011-050051
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Objectives: Since 2003, US organisations have recommended universal screening, rather than targeted screening, of HIV-infected persons for gonorrhoea and chlamydia. The objective of this study was to determine whether wider testing resulting from these guidelines would produce an increase in gonorrhoea/chlamydia diagnoses. Methods: 3283 patients receiving HIV care in 1999–2007 in the Johns Hopkins Hospital HIV clinic were studied. The two primary outcomes were the occurrence of any gonorrhoea/chlamydia testing in each year of care and the occurrence of any positive result(s) in years of testing. The proportion of all patients in care who were diagnosed with gonorrhoea/chlamydia was defined as the number of patients with positive results divided by the number of patients in care. Trends were analysed with repeated measures logistic regression. Results: The proportion of patients tested for gonorrhoea/chlamydia increased steadily from 0.12 in 1999 to 0.33 in 2007 (OR per year for being tested 1.17, 95% CI 1.15 to 1.19). The proportion positive among those tested decreased significantly after 2003 (OR per year 0.67, 95% CI 0.55 to 0.81). The proportion of all patients in care diagnosed with gonorrhoea/chlamydia therefore remained generally stable in 1999–2007 (OR per year 0.97, 95% CI 0.91 to 1.04). Conclusions: Universal annual screening, as implemented, did not increase the proportion of all patients in care who were diagnosed with gonorrhoea/chlamydia. Similarly low implementation rates have been reported in cross-sectional studies. If future efforts to enhance implementation do not yield increases in diagnoses, then guidelines focusing on targeted screening of high-risk groups rather than universal screening may be warranted.