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Increased gonorrhoea and chlamydia testing did not increase case detection in an HIV clinical cohort 1999–2007
  1. Stephen A Berry1,
  2. Khalil G Ghanem1,
  3. Kathleen R Page1,
  4. Stephen J Gange2,
  5. Chloe L Thio1,
  6. Richard D Moore1,2,
  7. Kelly A Gebo1,2
  1. 1Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Stephen A Berry, Division of Infectious Diseases, 1830 E. Monument Street, Suite 452, Baltimore, MD 21287-2100, USA; sberry8{at}jhmi.edu

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.

  • 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

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Footnotes

  • Conference presentation: The findings herein were presented, in part, at the 47th Annual Meeting of the Infectious Diseases Society of America, 1 November 2009, oral abstract #1258.

  • Funding This study received funding from the National Institutes of Health K23AI084854, R01 AG026250, R01 DA011602, R01 AA16893, K24 DA00432 and the National Center for Research Resources KL2RR025006-01.

  • Competing interests RDM has been a consultant for Bristol-Myers Squibb and has received research funding from Merck, Pfizer, and Gilead. KAG has been a consultant and received research funding from Tibotec. All other authors report no conflicts of interest.

  • Ethics approval This study received ethics approval from the Johns Hopkins School of Medicine Institutional Review Board (NA_00028824).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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