A Missed Opportunity: Extragenital Screening for Gonorrhea and Chlamydia Sexually Transmitted Infections in People With HIV in a Southeastern Ryan White HIV/AIDS Program Clinic Setting.
A Missed Opportunity: Extragenital Screening for Gonorrhea and Chlamydia Sexually Transmitted Infections in People With HIV in a Southeastern Ryan White HIV/AIDS Program Clinic Setting.
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错过的机会：东南部Ryan白色HIV/AIDS项目诊所环境中HIV感染者淋病和衣原体性传播感染的生殖器外筛查
DOI：
10.1093/ofid/ofac322
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发表时间：
2022-07
影响因子：
4.2
通讯作者：
中科院分区：
文献类型：
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作者：
指南建议每年在多个部位（泌尿生殖道、口咽、直肠）对性活跃的艾滋病毒感染者进行淋病/衣原体筛查。在Ryan白色HIV/AIDS项目诊所进行多点筛查的第一年，我们研究了（1）性史记录率，（2）性传播感染（STI）筛查率，（3）与STI相关的特征，以及（4）如果没有多点筛查，可能会漏诊的生殖器外STI的百分比。参与者年龄≥14岁，2019年在我们的诊所接受过≥1次亲自医疗访视。进行描述性分析，并调整测试的网站数量，对数二项模型被用来估计特征和STI诊断之间的关联。在这个队列（n = 857）中，21%没有记录性史。几乎所有性传播感染诊断都是男性（99.3%）。68%（253/375）接受了适当的泌尿生殖系统检查，63%（85/134）接受了适当的口咽检查，69%（72/105）接受了适当的直肠检查。在≥1次STI检测的男性参与者中（n = 347），西班牙裔种族和可检测到的HIV病毒载量与STI诊断相关。在那些被诊断患有性传播感染的人中，96%（n = 25/26）仅在生殖器外部位呈阳性。所有解剖部位的筛查率相似，表明对生殖器外检测无明显偏倚。在男性中，性传播感染在西班牙裔和可检测到病毒载量的人群中更常见，这可能表明这些人群中有更多的无套性行为。基于仅在生殖器外部位检测到的感染，我们的诊所在实施多点筛查之前可能对性传播感染诊断不足。
Guidelines recommend annual screening for gonorrhea/chlamydia in sexually active people with HIV at multiple sites (urogenital, oropharyngeal, rectal). In the first year of multisite screening at our Ryan White HIV/AIDS Program clinic, we studied (1) sexual history documentation rate, (2) sexually transmitted infection (STI) screening rate, (3) characteristics associated with STIs, and (4) the percentage of extragenital STIs that would have been missed without multisite screening. Participants were ≥14 years old with ≥1 in-person medical visit at our clinic in 2019. Descriptive analyses were performed, and adjusting for number of sites tested, a log-binomial model was used to estimate the association between characteristics and STI diagnosis in men. In this cohort (n = 857), 21% had no sexual history recorded. Almost all STI diagnoses were among males (99.3%). Sixty-eight percent (253/375) received appropriate urogenital testing, 63% (85/134) received appropriate oropharyngeal testing, and 69% (72/105) received appropriate rectal testing. In male participants with ≥1 STI test (n = 347), Hispanic ethnicity and having a detectable HIV viral load were associated with an STI diagnosis. Of those diagnosed with an STI who had multisite testing, 96% (n = 25/26) were positive only at an extragenital site. Screening rates were similar across all anatomical sites, indicating no obvious bias against extragenital testing. In males, STIs were more frequently diagnosed in people who identify as Hispanic and those with detectable viral loads, which may indicate more condomless sex in these populations. Based on infections detected exclusively at extragenital sites, our clinic likely underdiagnosed STIs before implementation of multisite screening.
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DOI：
10.15585/mmwr.mm6950a6
发表时间：
2020-12-18
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
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作者：
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通讯作者：
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作者：
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通讯作者：
Halperin, DT
影响因子：
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作者：
Temple-Smith, MJ;Mulvey, G;Keogh, L
通讯作者：
Keogh, L
影响因子：
8.4
作者：
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通讯作者：
Nielsen-Saines, Karin
影响因子：
3.1
作者：
Hoover, Karen W.;Butler, Mary;Kent, Charlotte K.
通讯作者：
Kent, Charlotte K.