[procaare] Australia -Screening for STIs in individuals with HIV infection

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Screening for STIs in individuals with HIV infection
N A Lister1, C K Fairley1, T Read2 and A Mijch3
Sex Transm Inf 2002;78:387-388
http://sti.bmjjournals.com/cgi/content/full/78/5/387-a
*****************

Correspondence to:
Professor C K Fairley, School of Population Health, 2nd Floor, 723 Swanston Street,
Carlton 3053, Australia; cfairley@unimelb.edu.au

In Australia, Victoria has seen an increase in new HIV cases from 1999 to 2000,1 and this
rise has been sustained in 2001. The rise primarily involves men who have sex with men
(MSM), where rates of unprotected anal intercourse and bacterial sexually transmitted
infections (STIs) have also increased.1 As bacterial STIs enhance HIV transmission,2
screening for asymptomatic infections may reduce the incidence of HIV.

A sexual health service in Melbourne reviewed medical records of MSM clients with HIV
infection. This was conducted to determine how commonly STI screening of asymptomatic
clients is performed and the proportion with bacterial STIs. At the sexual health clinic
the records of MSM with HIV care primarily at that clinic between 10 January 2001 and 1
March 2002 were reviewed. Any record of bacterial STI screening in the last year, the
anatomical sites screened, and the laboratory results of screening were collected on
printed forms. At the Alfred hospital a pilot programme screening asymptomatic clients
with HIV (n = 40) was undertaken in the outpatient department between 30 October 2001 and
4 December 2001.

Of the 66 sexual health clinic records fulfilling the criteria, 22 (33%) had screening for
bacterial STIs, and eight were tested at all anatomical sites of infection (urethra,
rectum, throat). Of the 22 tested, three (14%) tested positive for Neisseria gonorrhoeae
(NG) by culture and/or Chlamydia trachomatis (CT) by ligase chain reaction (LCR). Three
had rectal infection (NG = 2, CT = 3), two also had pharyngeal infection (NG = 2), and one
also had urethral infection (CT = 1). At the Alfred Hospital 40 clients had swabs taken
from all sites. Of these 40, eight (20%) HIV infected clients had rectal NG detected by
polymerase chain reaction (PCR) with confirmatory assay.

We identified a relatively high proportion of infections in those screened?11 positive of
the 62 tested (18%, 95% CI 9% to 30%). These findings to do not mean that these
individuals have been placing others at risk of HIV transmission because STIs may be
acquired from unprotected sexual contact with other HIV infected individuals, or through
sexual contact that is low risk for HIV transmission. Nevertheless, it would seem prudent
to reduce the prevalence of STIs by making screening a routine part of the management of
MSM. In the United States STI screening is recommended,3 and screening of MSM is also
recommended in the draft "STI management guidelines for priority populations" from the
Australasian College of Sexual Health Physicians (Chris Bourne, personal communication).

The completion of medical record reviews, the analysis, and drafting of this letter did
not involve funding.

References
Hocking J, Crofts N. HIV Surveillance in Victoria in 2000. Victorian Government Department
of Human Services, Melbourne. Victorian Infectious Diseases Bulletin 2001;4:1?3.
Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and
practice: the contribution of other sexually transmitted diseases to sexual transmission
of HIV infection. Sex Transm Infect 1999;75:3?17..[Abstract]
Anonymous. HIV prevention through early detection and treatment of other sexually
transmitted diseases?United States. Recommendations of the Advisory Committee for HIV and
STD prevention. Mor Mortal Wkly Rep CDC Surveill Summ 1998;47(RR-12):1?24.

© 2002 Sexually Transmitted Infections

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