Dean Bonnie B, Scott Mia, Hart Rachel, Battalora Linda, Novak Richard M, Durham Marcus D, Brooks John T, Buchacz Kate
From the *Cerner Corporation, Kansas City, MO; †Apex Family Medicine, Denver; ‡Colorado School of Mines, Golden, CO; §University of Illinois, Chicago, IL; and ¶Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Sex Transm Dis. 2017 Nov;44(11):678-684. doi: 10.1097/OLQ.0000000000000664.
In the United States, sexually transmitted infection (STI) testing is recommended at least annually for sexually active men who have sex with men (MSM). We evaluated human immunodeficiency virus (HIV) providers' STI testing practices and frequency of positive test results.
We analyzed data from HIV Outpatient Study (HOPS) participants who, from 2007 to 2014, completed a confidential survey about risk behaviors. Using medical records data, we assessed the frequency of gonorrhea, chlamydia, and syphilis testing and positive results during the year after the survey for MSM who reported sex without a condom in the prior 6 months. We compared testing frequency and positivity for men having 1, 2 to 3, and 4 or more sexual partners. Correlates of STI testing were assessed using general linear model to derive relative risks (RR) with associated 95% confidence intervals (CI).
Among 719 MSM, testing frequency was 74.5%, 74.3%, and 82.9% for gonorrhea, chlamydia, and syphilis, respectively, and was higher in those men who reported more sexual partners (P < 0.001 for all). In multivariable analysis, testing for gonorrhea was significantly more likely among non-Hispanic black versus white men (RR, 1.17; 95% CI, 1.03-1.33), among men seen in private versus public clinics (RR, 1.16; 95% CI, 1.05-1.28), and among men with 2 to 3 and 4 or more sexual partners versus 1 partner (RR, 1.12; 95% CI, 1.02-1.23, and RR, 1.18; 95% CI, 1.08-1.30, respectively). Correlates of chlamydia and syphilis testing were similar. Test positivity was higher among men with more sexual partners: for gonorrhea 0.0%, 3.0%, and 6.7% for men with 1, 2 to 3, and 4 or more partners, respectively (P < 0.001, syphilis 3.7%, 3.8% and 12.5%, P < 0.001).
Among HIV-infected MSM patients in HIV care who reported sex without a condom, subsequent testing was not documented in clinic records during the following year for up to a quarter of patients. Exploring why STI testing did not occur may improve patient care.
在美国，建议性活跃的男男性行为者（MSM）至少每年进行一次性传播感染（STI）检测。我们评估了人类免疫缺陷病毒（HIV）感染者的STI检测实践及检测结果呈阳性的频率。
我们分析了HIV门诊研究（HOPS）参与者的数据，这些参与者在2007年至2014年期间完成了一项关于风险行为的保密调查。利用病历数据，我们评估了在调查后一年中，报告在前6个月有无保护性行为的MSM的淋病、衣原体和梅毒检测频率及阳性结果。我们比较了有1个、2至3个以及4个或更多性伴侣的男性的检测频率和阳性率。使用一般线性模型评估STI检测的相关因素，以得出相对风险（RR）及相关的95%置信区间（CI）。
在719名MSM中，淋病、衣原体和梅毒的检测频率分别为74.5%、74.3%和82.9%，报告有更多性伴侣的男性检测频率更高（所有P<0.001）。在多变量分析中，非西班牙裔黑人男性比白人男性淋病检测的可能性显著更高（RR，1.17；95%CI，1.03 - 1.33），在私立诊所就诊的男性比在公立诊所就诊的男性淋病检测的可能性显著更高（RR，1.16；95%CI，1.05 - 1.28），有2至3个和4个或更多性伴侣的男性比有1个性伴侣的男性淋病检测的可能性显著更高（RR，1.12；95%CI，1.02 - 1.23和RR，1.18；95%CI，1.08 - 1.30）。衣原体和梅毒检测的相关因素相似。有更多性伴侣的男性检测阳性率更高：淋病方面，有1个、2至3个和4个或更多性伴侣的男性阳性率分别为0.0%、3.0%和6.7%（P<0.001），梅毒方面分别为3.7%、3.8%和12.5%（P<0.001）。
在接受HIV治疗且报告有无保护性行为的HIV感染MSM患者中，在接下来的一年里，多达四分之一患者的后续检测在临床记录中未被记录。探究STI检测未进行的原因可能会改善患者护理。
