Background Since 2003, national guidelines recommend that all new HIV patients undergo screening for sexually transmitted diseases (STD) during their initial visit. We evaluated STD screening practises in new patients attending an HIV Primary Care Clinic in North Carolina.
Methods This retrospective cohort study included HIV-infected patients greater than 18 years of age enrolled in the clinic between January 1, 2008 and December 31, 2010. Data on rapid plasma reagin (RPR) testing for syphilis and Neisseria gonorrheoeae (GC) and Chlamydia trachomatis (CT) testing by site of exposure, within 1 year of the new patient visit, were extracted via chart review to examine comprehensiveness of STD screening practises.
Results Between 2008 and 2010, 693 (68% male and 32% female) new patients entered care, most of whom were screened for syphilis within one year of the new patient visit (94.5% in 2008, 96.6% in 2009, 96.9% in 2010, p = 0.41). In contrast, only 21.3% were tested for GC and CT within one year of the first visit in 2008, 34.3% in 2009, and 54.3% in 2010 (p = < 0.0001). Of those screened, the prevalence of past/current syphilis ranged from 8.4–10.1% (p = 0.81) while positive testing for either GC or CT ranged from 2.3–9.1% (p = 0.20). In 2008, 1 rectal and 1 pharyngeal GC and CT test was performed versus 9 rectal and 8 pharyngeal tests in 2009 and 20 rectal and 14 pharyngeal tests in 2010. Of these, 13.3% of rectal tests and 8.7% of pharyngeal tests were positive, in contrast to 3.7% of genital tests.
Conclusion While screening practises improved from 2008 to 2010, new HIV patients continue to be under-screened for gonorrhoea and chlamydia, particularly at extra-genital sites. This deficiency is particularly important as, of those screened, prevalence was higher in extra-genital compared to genital sites. Efforts should be made to increase routine extra-genital screening.