Background US guidelines now call for expanded extragenital testing for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (Ct) in HIV infected individuals. In January 2012, we instituted a new policy to promote routine three-site testing (genital, oropharyngeal, rectal) for GC/Ct among HIV-infected persons in our clinic population. The purpose of this study is to assess implementation of the “triple-dip” programme, as well as the prevalence and incidence of STI at each site.
Methods We conducted a retrospective chart review of HIV-infected patients seen in our clinic before (Jan.-Dec. 2011) and after (Jan.-Dec. 2012) implementation of a routine three-site testing policy, to compare GC/Ct prevalence during these two time periods. Self-reported behavioural data were also evaluated.
Results For the three months after the transitioning from symptom-triggered testing to routine three-site screening for GC/Ct, the number of oropharyngeal tests performed increased from 38 to 325, and the number of rectal tests increased from 32 to 290, an 8 to 9 fold increase in testing. Although the rate of infection at most sites decreased with increased screening, the rate of rectal GC/Ct remained unchanged (13% pre-expanded testing verses 12% after initiating broader testing, p = n.s.). This suggests that the prevalence of asymptomatic rectal infections in patients living with HIV in our clinic is high. Preliminary analyses indicate that rectal infections are more common in our tested patient population (12%) than at other sites of testing (4.5% oropharyngeal tests were positive, 1.5% genital tests were positive).
Conclusion Although extragenital testing increased with expanded testing, not all patients at risk were screened. Given the higher percentage of positive rectal tests, enhanced testing should focus on increasing awareness of rectal infection, treatment intervention, and risk counselling.
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