Gonorrhoea and chlamydia in persons with HIV: Number needed to screen

Susan Tuddenham, Khalil G Ghanem, Kelly Gebo, Richard D Moore, William Christopher Mathews, Allison Lorna Agwu, Kenneth Mayer, Christina Schumacher, Julia Raifman, Stephen Berry

Research output: Contribution to journalArticle

Abstract

Objectives: Current guidelines recommend screening sexually active persons with HIV (PWH) for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) at least annually. Yet, screening rates in many HIV clinics remain low. In this study, we estimated the number needed to screen (NNS) to detect a NG and/or CT infection at each anatomic site among different subpopulations of PWH. NNS provides a concrete, practical measure to aid in assessing the practical impact of screening. Methods: We included adults in care at three HIV Research Network sites in 2011-2014. Restricting to first tests within each year, annual NNS was defined as number of persons tested divided by number positive. We computed urogenital and extragenital NNS by age and risk group (women, men who have sex with women (MSW) and men who have sex with men (MSM)). Results: A total of 16 864 NG/CT tests were included. Among patients aged ≤25 years, urogenital NNS was similar among women (15 (95% CI 6 to 71)), MSW (21 (95% CI 6 to 167)) and MSM (20 (95% CI 12 to 36)). Over 25, urogenital NNS increased to a greater extent for women (363 (95% CI 167 to 1000)) and MSW (160 (95% CI 100 to 333)) than MSM (46 (95% CI 38 to 56)). The increase for women versus MSM >25 remained significant (p<0.01) in multivariable analysis. Among MSM, rectal NNS was 5 (95% CI 3 to 7) and 10 (95% CI 9 to 12) for ≤25 and for >25 years and pharyngeal NNS values were 8 (95% CI 5 to 13) and 20 (95% CI 16 to 24). Conclusions: These findings suggest the importance of regular, at least annual NG/CT screening, particularly extragenital, of HIV positive MSM of all ages. They provide some support for age-based cutoffs for women and MSW (eg, universal screening for those aged ≤25 and targeted screening for those aged >25 years).

Original languageEnglish (US)
JournalSexually Transmitted Infections
DOIs
StatePublished - Jan 1 2019

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Chlamydia
Gonorrhea
Neisseria gonorrhoeae
Chlamydia trachomatis
HIV
Chlamydia Infections
Age Groups
Guidelines
Research

Keywords

  • chlamydia
  • gonorrhea
  • HIV
  • sexually transmitted diseases

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

Cite this

@article{c79ce9819b7b4e908746dca5b2fc4555,
title = "Gonorrhoea and chlamydia in persons with HIV: Number needed to screen",
abstract = "Objectives: Current guidelines recommend screening sexually active persons with HIV (PWH) for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) at least annually. Yet, screening rates in many HIV clinics remain low. In this study, we estimated the number needed to screen (NNS) to detect a NG and/or CT infection at each anatomic site among different subpopulations of PWH. NNS provides a concrete, practical measure to aid in assessing the practical impact of screening. Methods: We included adults in care at three HIV Research Network sites in 2011-2014. Restricting to first tests within each year, annual NNS was defined as number of persons tested divided by number positive. We computed urogenital and extragenital NNS by age and risk group (women, men who have sex with women (MSW) and men who have sex with men (MSM)). Results: A total of 16 864 NG/CT tests were included. Among patients aged ≤25 years, urogenital NNS was similar among women (15 (95{\%} CI 6 to 71)), MSW (21 (95{\%} CI 6 to 167)) and MSM (20 (95{\%} CI 12 to 36)). Over 25, urogenital NNS increased to a greater extent for women (363 (95{\%} CI 167 to 1000)) and MSW (160 (95{\%} CI 100 to 333)) than MSM (46 (95{\%} CI 38 to 56)). The increase for women versus MSM >25 remained significant (p<0.01) in multivariable analysis. Among MSM, rectal NNS was 5 (95{\%} CI 3 to 7) and 10 (95{\%} CI 9 to 12) for ≤25 and for >25 years and pharyngeal NNS values were 8 (95{\%} CI 5 to 13) and 20 (95{\%} CI 16 to 24). Conclusions: These findings suggest the importance of regular, at least annual NG/CT screening, particularly extragenital, of HIV positive MSM of all ages. They provide some support for age-based cutoffs for women and MSW (eg, universal screening for those aged ≤25 and targeted screening for those aged >25 years).",
keywords = "chlamydia, gonorrhea, HIV, sexually transmitted diseases",
author = "Susan Tuddenham and Ghanem, {Khalil G} and Kelly Gebo and Moore, {Richard D} and Mathews, {William Christopher} and Agwu, {Allison Lorna} and Kenneth Mayer and Christina Schumacher and Julia Raifman and Stephen Berry",
year = "2019",
month = "1",
day = "1",
doi = "10.1136/sextrans-2018-053793",
language = "English (US)",
journal = "Sexually Transmitted Infections",
issn = "1368-4973",
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TY - JOUR

T1 - Gonorrhoea and chlamydia in persons with HIV

T2 - Number needed to screen

AU - Tuddenham, Susan

AU - Ghanem, Khalil G

AU - Gebo, Kelly

AU - Moore, Richard D

AU - Mathews, William Christopher

AU - Agwu, Allison Lorna

AU - Mayer, Kenneth

AU - Schumacher, Christina

AU - Raifman, Julia

AU - Berry, Stephen

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: Current guidelines recommend screening sexually active persons with HIV (PWH) for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) at least annually. Yet, screening rates in many HIV clinics remain low. In this study, we estimated the number needed to screen (NNS) to detect a NG and/or CT infection at each anatomic site among different subpopulations of PWH. NNS provides a concrete, practical measure to aid in assessing the practical impact of screening. Methods: We included adults in care at three HIV Research Network sites in 2011-2014. Restricting to first tests within each year, annual NNS was defined as number of persons tested divided by number positive. We computed urogenital and extragenital NNS by age and risk group (women, men who have sex with women (MSW) and men who have sex with men (MSM)). Results: A total of 16 864 NG/CT tests were included. Among patients aged ≤25 years, urogenital NNS was similar among women (15 (95% CI 6 to 71)), MSW (21 (95% CI 6 to 167)) and MSM (20 (95% CI 12 to 36)). Over 25, urogenital NNS increased to a greater extent for women (363 (95% CI 167 to 1000)) and MSW (160 (95% CI 100 to 333)) than MSM (46 (95% CI 38 to 56)). The increase for women versus MSM >25 remained significant (p<0.01) in multivariable analysis. Among MSM, rectal NNS was 5 (95% CI 3 to 7) and 10 (95% CI 9 to 12) for ≤25 and for >25 years and pharyngeal NNS values were 8 (95% CI 5 to 13) and 20 (95% CI 16 to 24). Conclusions: These findings suggest the importance of regular, at least annual NG/CT screening, particularly extragenital, of HIV positive MSM of all ages. They provide some support for age-based cutoffs for women and MSW (eg, universal screening for those aged ≤25 and targeted screening for those aged >25 years).

AB - Objectives: Current guidelines recommend screening sexually active persons with HIV (PWH) for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) at least annually. Yet, screening rates in many HIV clinics remain low. In this study, we estimated the number needed to screen (NNS) to detect a NG and/or CT infection at each anatomic site among different subpopulations of PWH. NNS provides a concrete, practical measure to aid in assessing the practical impact of screening. Methods: We included adults in care at three HIV Research Network sites in 2011-2014. Restricting to first tests within each year, annual NNS was defined as number of persons tested divided by number positive. We computed urogenital and extragenital NNS by age and risk group (women, men who have sex with women (MSW) and men who have sex with men (MSM)). Results: A total of 16 864 NG/CT tests were included. Among patients aged ≤25 years, urogenital NNS was similar among women (15 (95% CI 6 to 71)), MSW (21 (95% CI 6 to 167)) and MSM (20 (95% CI 12 to 36)). Over 25, urogenital NNS increased to a greater extent for women (363 (95% CI 167 to 1000)) and MSW (160 (95% CI 100 to 333)) than MSM (46 (95% CI 38 to 56)). The increase for women versus MSM >25 remained significant (p<0.01) in multivariable analysis. Among MSM, rectal NNS was 5 (95% CI 3 to 7) and 10 (95% CI 9 to 12) for ≤25 and for >25 years and pharyngeal NNS values were 8 (95% CI 5 to 13) and 20 (95% CI 16 to 24). Conclusions: These findings suggest the importance of regular, at least annual NG/CT screening, particularly extragenital, of HIV positive MSM of all ages. They provide some support for age-based cutoffs for women and MSW (eg, universal screening for those aged ≤25 and targeted screening for those aged >25 years).

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KW - gonorrhea

KW - HIV

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