STD Screening of HIV-Infected MSM in HIV Clinics
STD Screening of HIV-Infected MSM in HIV Clinics
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DOI：
10.1097/olq.0b013e3181e50058
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发表时间：
2010-12-01
影响因子：
3.1
通讯作者：
Kent, Charlotte K.
中科院分区：
文献类型：
--
作者：
Hoover, Karen W.;Butler, Mary;Kent, Charlotte K.
背景：国家人类免疫缺陷病毒（HIV）感染者护理指南推荐对性传播疾病（STDs）进行无症状常规筛查。我们的目的是确定护理感染艾滋病毒的男男性行为者（MSM）的提供者是否遵循这些指南。方法：选取美国6个城市8家大型艾滋病诊所的医疗记录，对性病筛查进行评估。我们估计了2004年、2005年和2006年至少做过一次梅毒、衣原体（尿道和/或直肠）或淋病（尿道、直肠和/或咽）检测的男性人数。尿道检测包括尿样和尿道拭子核酸扩增检测。我们还计算了筛查男性中梅毒、衣原体和淋病的阳性率。结果：提取了2004-2006年14659次就诊的1334例hiv感染者的医疗记录。2004-2006年期间，每年的梅毒筛查率从66.0%到75.8%不等。直肠衣原体和直肠及咽淋病的年度筛查率为2.3%至8.5%，尽管在此期间无症状患者标本中有中度至高阳性率（3.0%-9.8%）。每年尿道衣原体和淋病筛查率高于非尿道部位，但不理想，范围为13.8%至18.3%。结论：大多数无症状hiv感染的男男性行为者都进行了梅毒筛查，表明提供者很好地遵守了这一筛查指南。淋病和衣原体的低筛查率，特别是在直肠和咽部位，表明在遵守这些指南方面存在重大障碍。无症状衣原体和淋球菌感染的中高流行率强调了筛查的重要性。需要采取一系列提高临床质量的干预措施来增加筛查，包括提高对非尿道筛查的核酸扩增检测的认识。
Background: National guidelines for the care of human immunodeficiency virus (HIV)-infected persons recommend asymptomatic routine screening for sexually transmitted diseases (STDs). Our objective was to determine whether providers who care for HIV-infected men who have sex with men (MSM) followed these guidelines.Methods: We abstracted medical records to evaluate STD screening at 8 large HIV clinics in 6 US cities. We estimated the number of men who had at least one test for syphilis, chlamydia (urethral and/or rectal), or gonorrhea (urethral, rectal, and/or pharyngeal) in 2004, 2005, and 2006. Urethral testing included nucleic acid amplification tests of both urethral swabs and urine. We also calculated the positivity of syphilis, chlamydia, and gonorrhea among screened men.Results: Medical records were abstracted for 1334 HIV-infected MSM who made 14,659 visits from 2004-2006. The annual screening rate for syphilis ranged from 66.0% to 75.8% during 2004-2006. Rectal chlamydia and rectal and pharyngeal gonorrhea annual screening rates ranged from 2.3% to 8.5% despite moderate to high positivity among specimens from asymptomatic patients (3.0%-9.8%) during this period. Annual urethral chlamydia and gonorrhea screening rates were higher than rates for nonurethral sites, but were suboptimal, and ranged from 13.8% to 18.3%.Conclusions: Most asymptomatic HIV-infected MSM were screened for syphilis, indicating good provider adherence to this screening guideline. Low screening rates for gonorrhea and chlamydia, especially at rectal and pharyngeal sites, suggest that substantial barriers exist for complying with these guidelines. The moderate to high prevalence of asymptomatic chlamydial and gonococcal infections underscores the importance of screening. A range of clinical quality improvement interventions are needed to increase screening, including increasing the awareness of nucleic acid amplification tests for nonurethral screening.