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Introduction: Sexually transmitted infections (STIs) are a major public health problem. Two factors make their diagnosis challenging: frequent asymptomatic presentation and lack of screening, especially at extragenital sites. Additionally, STIs including gonorrhea (GC) and chlamydia (CT) have been shown to increase the risk of sexual HIV transmission. Information about the prevalence, as well as predictors of test positivity, of GC and CT infections can stress the importance of universal screening.

Methods: We carried out a retrospective analysis of the STI screening of patients who attended the Ryan White HIV clinic at Jefferson between 2016 and 2018. The primary outcomes were positive GC/CT tests from genital, oral, and rectal sites. A secondary outcome was a positive syphilis screening. We also collected patient demographic information and risk factors for HIV transmission, including injection drug use status, history of prior STI, date of HIV diagnosis, condom use, number of sexual partners, and adherence to antiretroviral therapy.

Results: On preliminary analysis of 290 out of 372 patients (61.6% male, 39.2% MSM, 37.1% female, and 1.3% transgender) we analyzed 532 genital, 126 oral, and 104 rectal GC/CT screens. We recorded 12 genital (2.3%), 12 oral (9.5%), and 22 rectal (21.1%) positive test results. Patients with oral and rectal GC/CT were more likely to be asymptomatic (92% and 91%, respectively) compared to genital (25%). We analyzed 688 syphilis screens, of which 28 were positive. Of these, 61% were asymptomatic.

Discussion: Given the high rate of asymptomatic infections, our results emphasize the need for universal STI screening in primary care and HIV care settings to increase diagnosis and treatment, preventing downstream complications and HIV transmission risk.