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Gonorrhoea and chlamydia screening in HIV clinics: time for new tools and targets
  1. Stephen A Berry
  1. Correspondence to Dr Stephen A Berry, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 725 N. Wolfe St. / Office 217, Baltimore, MD 21205, USA, sberry8{at}jhmi.edu

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Prevalence studies indicate approximately 10% of patients in HIV clinics may be infected with Neisseria gonorrhoeae (NG) and/or Chlamydia trachomatis (CT) at any given time.1–3 Detecting and treating these mostly asymptomatic infections may decrease HIV transmission by prompting counselling to avoid risky sexual exposures and by reducing mucosal inflammation and HIV RNA level. Guidelines for annual NG/CT screening of sexually active persons living with HIV (PLWH) have been issued in North America, Europe and Australia. Observation of actual NG/CT testing and case detection in clinical practice can inform efforts to increase compliance with screening guidelines and the appropriate revision of guidelines.

The study by Burchell and colleagues in this issue of the journal observed 3165 patients among seven HIV clinics in Ontario, Canada, during 2008–2011.4 The proportion of patients tested annually for NG/CT rose from 15% in 2008 to 27% in 2011; however, test positivity declined, yielding a relatively stable case detection rate (the percentage of all patients in care diagnosed with NG and/or CT whether tested or not) of approximately 1.8% per year. Overall, 95% of the 150 positive results occurred among men who have sex with men (MSM), who made up 69% of the clinic population. In all, 91% of NG/CT assays were of the genital tract, 4% of the rectum and 5% the oral pharynx. The study was partly limited because data were not captured for all laboratories to which NG/CT tests may have been sent and because the …

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