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In Australia, Victoria has seen an increase in new HIV cases from 1999 to 2000,1 and this rise has been sustained in 2001. The rise primarily involves men who have sex with men (MSM), where rates of unprotected anal intercourse and bacterial sexually transmitted infections (STIs) have also increased.1 As bacterial STIs enhance HIV transmission,2 screening for asymptomatic infections may reduce the incidence of HIV.
A sexual health service in Melbourne reviewed medical records of MSM clients with HIV infection. This was conducted to determine how commonly STI screening of asymptomatic clients is performed and the proportion with bacterial STIs. At the sexual health clinic the records of MSM with HIV care primarily at that clinic between 10 January 2001 and 1 March 2002 were reviewed. Any record of bacterial STI screening in the last year, the anatomical sites screened, and the laboratory results of screening were collected on printed forms. At the Alfred hospital a pilot programme screening asymptomatic clients with HIV (n = 40) was undertaken in the outpatient department between 30 October 2001 and 4 December 2001.
Of the 66 sexual health clinic records fulfilling the criteria, 22 (33%) had screening for bacterial STIs, and eight were tested at all anatomical sites of infection (urethra, rectum, throat). Of the 22 tested, three (14%) tested positive for Neisseria gonorrhoeae (NG) by culture and/or Chlamydia trachomatis (CT) by ligase chain reaction (LCR). Three had rectal infection (NG = 2, CT = 3), two also had pharyngeal infection (NG = 2), and one also had urethral infection (CT = 1). At the Alfred Hospital 40 clients had swabs taken from all sites. Of these 40, eight (20%) HIV infected clients had rectal NG detected by polymerase chain reaction (PCR) with confirmatory assay.
We identified a relatively high proportion of infections in those screened—11 positive of the 62 tested (18%, 95% CI 9% to 30%). These findings to do not mean that these individuals have been placing others at risk of HIV transmission because STIs may be acquired from unprotected sexual contact with other HIV infected individuals, or through sexual contact that is low risk for HIV transmission. Nevertheless, it would seem prudent to reduce the prevalence of STIs by making screening a routine part of the management of MSM. In the United States STI screening is recommended,3 and screening of MSM is also recommended in the draft “STI management guidelines for priority populations” from the Australasian College of Sexual Health Physicians (Chris Bourne, personal communication).
The data extraction was carried out by all authors and analysed by NL and CF. The article was drafted by all authors and all have approved the final draft. The authors declare that they have no conflict of interest in connection with this paper.
The completion of medical record reviews, the analysis, and drafting of this letter did not involve funding.