TY - JOUR
T1 - Sexually transmitted infection screening among gay, bisexual, and other men who have sex with men prescribed pre-exposure prophylaxis in Baltimore City, Maryland
AU - the IMPACT Partner Collaborative
AU - Schumacher, Christina
AU - Wu, Linxuan
AU - Chandran, Aruna
AU - Fields, Errol
AU - Price, Ashley
AU - Greenbaum, Adena
AU - Jennings, Jacky M.
AU - Page, Kathleen
AU - Davis, Maisha
AU - Ryscavage, Patrick
AU - Jones, Joyce Leitch
AU - Farley, Jason
AU - Arrington-Sanders, Renata
AU - Tepper, Vicki
AU - Demissew, Mimi
N1 - Funding Information:
This study was supported by the Centers for Disease Control and Prevention grant entitled Understanding Syphilis Transmission in the United States (grant number 1U01PS005171-01) (co-Principal Investigators: J. M. J., A. G.); Centers for Disease Control and Prevention Grant entitled Health Department Demonstration Projects for Comprehensive Prevention, Care, Behavioral Health, and Social Services for Men Who Have Sex with Men of Color at Risk for and Living with human immunodeficiencyvirus (HIV) Infection (grant number PS15-1509); Centers for Disease Control and Prevention grant entitled Health Department Demonstration Projects to Reduce HIV Infections and Improve Health Outcomes for Men Who Have Sex with Men of Color at Risk for and Living with HIV Infection (grant number 15-1506); and the Centers for Disease Control and Prevention grant entitled STD Surveillance Network (grant number PS13-1306) (co-Principal Investigators: C. S., A. G.)
Publisher Copyright:
© The Author(s) 2019.
PY - 2020/11/15
Y1 - 2020/11/15
N2 - Background. Human immunodeficiency virus pre-exposure prophylaxis (PrEP) clinical guidelines recommend men who have sex with men (MSM) PrEP users be screened biannually for syphilis and gonorrhea/chlamydia at all anatomic sites. We sought to determine the proportion screened and positive by STI and anatomic site at PrEP initiation and PrEP-care visits and patient-level characteristics associated with screening among MSM PrEP users in Baltimore City, Maryland. Methods. Medical records among MSM initiating PrEP between 30 September 2015 and 31 March 2018 were abstracted. STI screening (syphilis and gonorrhea/chlamydia at all anatomic sites) and positivity at PrEP visits ≤12 months following initiation were calculated. Poisson regression with cluster robust SEs was used to assess associations with STI screening. Results. Among 290 MSM initiating PrEP, 43.1% (n = 125) were screened per guidelines at PrEP initiation; 79.3% (230), 69.3% (201), 55.9% (162), and 69.3% (201) were screened for syphilis, urogenital, rectal, and oropharyngeal gonorrhea/chlamydia, respectively. Positivity among those screened was syphilis, 7.8% (n = 18/230); gonorrhea, 5.0% urogenital (10/201), 11.1% rectal (18/162), and 7.5% oropharyngeal (15/201); chlamydia, 5.0% urogenital (10/201), 11.7% rectal (19/162), and 1.5% oropharyngeal (3/201). Reported anal and oral sex (vs neither) was independently associated with STI screening (aPR, 2.11; 1.05–4.27) at PrEP initiation. At biannual PrEP-care visits, STI screening was lower and syphilis and rectal gonorrhea/chlamydia positivity was higher. Conclusions. Observed STI screening levels and disease burden suggest the effectiveness of STI screening in PrEP care for STI prevention may be limited. Our results suggest providers may be offering screening based on sexual practices; clarification of STI screening guidelines for PrEP users is needed.
AB - Background. Human immunodeficiency virus pre-exposure prophylaxis (PrEP) clinical guidelines recommend men who have sex with men (MSM) PrEP users be screened biannually for syphilis and gonorrhea/chlamydia at all anatomic sites. We sought to determine the proportion screened and positive by STI and anatomic site at PrEP initiation and PrEP-care visits and patient-level characteristics associated with screening among MSM PrEP users in Baltimore City, Maryland. Methods. Medical records among MSM initiating PrEP between 30 September 2015 and 31 March 2018 were abstracted. STI screening (syphilis and gonorrhea/chlamydia at all anatomic sites) and positivity at PrEP visits ≤12 months following initiation were calculated. Poisson regression with cluster robust SEs was used to assess associations with STI screening. Results. Among 290 MSM initiating PrEP, 43.1% (n = 125) were screened per guidelines at PrEP initiation; 79.3% (230), 69.3% (201), 55.9% (162), and 69.3% (201) were screened for syphilis, urogenital, rectal, and oropharyngeal gonorrhea/chlamydia, respectively. Positivity among those screened was syphilis, 7.8% (n = 18/230); gonorrhea, 5.0% urogenital (10/201), 11.1% rectal (18/162), and 7.5% oropharyngeal (15/201); chlamydia, 5.0% urogenital (10/201), 11.7% rectal (19/162), and 1.5% oropharyngeal (3/201). Reported anal and oral sex (vs neither) was independently associated with STI screening (aPR, 2.11; 1.05–4.27) at PrEP initiation. At biannual PrEP-care visits, STI screening was lower and syphilis and rectal gonorrhea/chlamydia positivity was higher. Conclusions. Observed STI screening levels and disease burden suggest the effectiveness of STI screening in PrEP care for STI prevention may be limited. Our results suggest providers may be offering screening based on sexual practices; clarification of STI screening guidelines for PrEP users is needed.
KW - HIV
KW - Men who have sex with men
KW - Pre-exposure prophylaxis
KW - Sexually transmitted infections
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U2 - 10.1093/cid/ciz1145
DO - 10.1093/cid/ciz1145
M3 - Article
C2 - 31761944
AN - SCOPUS:85100049555
SN - 1058-4838
VL - 71
SP - 2637
EP - 2644
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -