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. 2011 Oct;87(6):469-75.
doi: 10.1136/sextrans-2011-050051. Epub 2011 Jul 11.

Increased gonorrhoea and chlamydia testing did not increase case detection in an HIV clinical cohort 1999-2007

Stephen A Berry  1 , Khalil G Ghanem, Kathleen R Page, Stephen J Gange, Chloe L Thio, Richard D Moore, Kelly A Gebo
Affiliations

Increased gonorrhoea and chlamydia testing did not increase case detection in an HIV clinical cohort 1999-2007

Stephen A Berry et al. Sex Transm Infect. 2011 Oct.

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.

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Conflict of interest statement

Potential Conflicts of Interest: R.D.M has been a consultant for Bristol-Myers Squibb and has received research funding from Merck, Pfizer, and Gilead. K.A.G. has been a consultant and received research funding from Tibotec. All other authors: no conflicts.

Figures

Figure 1
Figure 1
Proportion tested and proportion diagnosed with NG/CT among all those in care. A, all subjects; B, women; C, men; and D, men who have sex with men.
Figure 2
Figure 2
Proportion positive among those tested for NG/CT. A, all subjects; B, women; C, men; and D, men who have sex with men.
See this image and copyright information in PMC

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