Routine STI Screening, Counseling Lower STI Rate in HIV+ US MSM

Screening for sexually transmitted infections (STIs) every 6 months and brief risk-reduction counseling halved STI incidence over 12 months in US men who have sex with men (MSM) enrolled in a prospective observational study.

STI prevalence and incidence (the new infection rate) remain high among MSM with and without HIV in the United States and other countries. Health authorities recommend regular STI screening in sexually active people with HIV, regardless of whether symptoms are apparent. But screening rates are low.

The SUN Study is a prospective observational study of HIV-positive people in four US cities. When people enroll in the SUN Study and every 6 months thereafter, they complete a behavioral survey and get tested for STIs. If they have an STI, they receive treatment.

This study involved 216 Sun Study MSM who received brief risk-reduction counseling. The investigators evaluated trends in STI incidence and self-reported risk behaviors before and after the risk-reduction intervention. The “preintervention” visit was the visit at least 6 months after the enrollment STI screening and counseling.

Median age of the 216 MSM was 44.5 years, 77% were non-Hispanic white, 83% were taking combination antiretroviral therapy, and 84% had a viral load below 400 copies/mL. Median CD4 count stood at 511 cells/µL.

STI incidence dropped from 8.8% at the preintervetnion visit to 4.2% a year later, a significant decline (P = 0.041).

Rates of unprotected receptive or insertive anal intercourse with HIV-positive partners rose significantly over the 12-month study period, from 19% to 25% (P = 0.024). But rates of unprotected anal intercourse did not change with HIV-negative partners or partners of unknown HIV status (24% to 22%, P = 0.590).

The SUN researchers believe their findings “support adoption of routine STI screening and risk-reduction counseling for HIV-infected MSM.”

Source: Pragna Patel, Tim Bush, Kenneth Mayer, Joel Milam, Jean Richardson, John Hammer, Keith Henry, Turner Overton, Lois Conley, Gary Marks, John T. Brooks, for the SUN Study Investigators. Routine brief risk-reduction counseling with biannual STD testing reduces STD incidence among HIV-infected men who have sex with men in care. Sexually Transmitted Diseases. 2012; 39: 470-474.

For the study abstract

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Written by Mark Mascolini on behalf of the International AIDS Society