Automated, computer generated reminders and increased detection of gonorrhoea, chlamydia and syphilis in men who have sex with men.

Huachun Zou,Christopher K Fairley,Jade Bilardi,Jun Kit Sze,Afrizal Afrizal,Rebecca Guy,Catriona S Bradshaw,Suzanne M Garland,Marcus Y Chen,Rupert Kaul

doi:10.1371/journal.pone.0061972

Abstract

BackgroundGuidelines recommend frequent screening of men who have sex with men (MSM) for sexually transmissible infections (STIs) but few interventions have demonstrated increased testing and detection of bacterial STIs among MSM in controlled studies.MethodsWe used automated text message and email reminders generated by computer assisted self-interview (CASI) to remind MSM to retest for syphilis. We compared clinic visits, STI testing and detection rates over 12 month between men receiving reminders (reminder group) and men not offered the reminders (concurrent control group).ResultsMen who chose 3-monthly reminders had more clinic visits (median 3 vs 1) and higher testing rates for pharyngeal gonorrhoea (67.0% vs 33.6%), rectal gonorrhoea (62.7% vs 31.1%), urethral chlamydia (67.3% vs 39.3%), rectal chlamydia (62.9% vs 31.3%), syphilis (67.0% vs 39.3%) and HIV (64.9% vs 36.7%) (all p<0.001) than concurrent controls, within 12 months after their first visit. Also, men receiving reminders had a higher combined testing rate for all the aforementioned STIs at a same visit (55.7% vs 25.5%, p<0.001) compared with concurrent controls. This association remained after adjusting for differences in characteristics between the two groups (adjusted odds ratio:1.77, 95% confidence interval:1.51-2.08). Men receiving reminders also had a higher detection rate of: rectal gonorrhoea (3.7% vs 1.2%, p = 0.001), urethral chlamydia (3.1% vs 1.4%, p = 0.027), rectal chlamydia (6.6% vs 2.8%, p<0.001), and early, latent syphilis (1.7% vs 0.4%, p = 0.008) compared with concurrent controls.ConclusionThis is the first study to demonstate that a fully automated reminder system using CASI was associated with increased detection of bacterial STIs among MSM.

Highlights

High prevalence rates of bacterial sexually transmissible infections (STIs) such as gonorrhoea, chlamydia and syphilis have been seen among men who have sex with men (MSM) [1,2,3,4]
MSM constitute an important risk group for HIV in many countries [5,6,7] Bacterial STIs are important in this population because of the morbidity they cause and because they enhance the transmission of HIV
Studies have demonstrated associations between bacterial STIs and HIV seroconversion in MSM [8,9]. These bacterial STIs are predominantly asymptomatic and require screening for detection [10,11]. Guidelines, including those from the United States Centers for Disease Control and Prevention recommend at least annual screening of MSM for: pharyngeal and rectal gonorrhoea, urethral and rectal chlamydia, syphilis, and HIV, with 3-6-monthly screening of higher risk men [12,13

Summary

Introduction

High prevalence rates of bacterial sexually transmissible infections (STIs) such as gonorrhoea, chlamydia and syphilis have been seen among men who have sex with men (MSM) [1,2,3,4]. Studies have demonstrated associations between bacterial STIs and HIV seroconversion in MSM [8,9] These bacterial STIs are predominantly asymptomatic and require screening for detection [10,11]. Guidelines, including those from the United States Centers for Disease Control and Prevention recommend at least annual screening of MSM for: pharyngeal and rectal gonorrhoea, urethral and rectal chlamydia, syphilis, and HIV, with 3-6-monthly screening of higher risk men [12,13. Guidelines recommend frequent screening of men who have sex with men (MSM) for sexually transmissible infections (STIs) but few interventions have demonstrated increased testing and detection of bacterial STIs among MSM in controlled studies

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Methods

Results

Conclusion