STI screening in people living with HIV: are we getting the whole story?

Abstract

People living with HIV are able to enjoy meaningful sexual relationships; there remains however the key responsibility of reducing transmission to others and within this the prevention and management of sexually transmitted infections (STIs). In 2008 and 2011 BHIVA published guidance on STI testing recommending annual STI screening in asymptomatic patients with consideration of more frequent screening dependent on risk. We conducted a retrospective case note review of 385 HIV‐positive patients presenting for routine HIV care in a large city teaching hospital HIV clinic during 2010. Data included demographics, HIV parameters, sexual history and STI screening were collected. 297 (77%) were male, 215 (56%) white British, 105 (27%) black African. 229 (56%) were MSM. Median age was 37 years (range 17–75) and the median year of diagnosis was 2005 (range 1998–2010). Median CD4 count was 467 cells/mm3 (range 1–1849) and undetectable viral load in 248 (64%). 296 (77%) were on HAART. 18 were co‐infected with HBV and 17 with HCV. 249 (65%) patients had at least one STI screen. 56 (15%) declined testing and 77 (20%) were not offered. 238 (62%) had regular partner(s) and of these 109 (46%) were known HIV‐positive and 128 (32%) reported casual partners. 11 (3%) had sex exclusively with HIV‐positive partners. 91 (69%) always used condoms for vaginal sex. With regards to anal sex, 16 (68%) always used condoms. 11% used condoms for oral sex. 25 patients (6.5%) had rectal chlamydia, 27 (7.0%) had rectal gonorrhoea, 8 had dual infection and 3 had LGV. 10 HSV, 12 syphilis and 6 acute HCV infections were diagnosed during this period. 172 patients reported monogamous relationship over 12 months 11 (6.4%) of these had STIs. 160 reported consistent condom use for anal sex; of these 24 (15%) had rectal STIs diagnosed. Routine STI screening is offered annually in our cohort with reasonable uptake rates. STIs are still being diagnosed in people living with HIV despite our repeated safe sex messages and self‐reported condom use. In our cohort this was almost exclusively in MSM. Sexual history and safe sex education should be included at each visit. STI screening should be offered annually even in those reporting monogamous relationships and more frequently dependent on sexual history.