Sexually Transmitted Infection Screening among Gay, Bisexual, and Other Men Who Have Sex with Men Prescribed Pre-exposure Prophylaxis in Baltimore City, Maryland

BACKGROUND HIV Pre-exposure prophylaxis(PrEP) clinical guidelines recommend men who have sex with men(MSM) PrEP users be screened biannually for syphilis and gonorrhea/chlamydia at all anatomic sites. Our objectives were to determine: 1)the proportion screened and testing positive by STI and anatomic site at PrEP initiation and PrEP-Care visits; and 2)patient-level characteristics associated with screening among MSM PrEP users in Baltimore City, Maryland. METHODS Medical records among MSM initiating PrEP between September 30, 2015-March 31, 2018 were abstracted. STI screening for syphilis AND gonorrhea/chlamydia at all anatomic sites and positivity at PrEP visits < 12 months following initiation were calculated. Poisson regression with cluster robust standard errors was used to determine characteristics associated with STI screening. RESULTS Among 290 MSM initiating PrEP, 43.1%(n=125) were screened per guidelines at PrEP initiation. 79.3%(n=230), 69.3%(n=201), 55.9%(n=162), and 69.3%(n=201) were screened for syphilis, urogenital, rectal, and oropharyngeal gonorrhea/chlamydia, respectively. Positivity among those screened was: syphilis: 7.8%(n=18/230); gonorrhea: 5.0% urogenital(n=10/201), 11.1% rectal(n=18/162), and 7.5% oropharyngeal(n=15/201); chlamydia: 5.0% urogenital(n=10/201), 11.7% rectal(n=19/162) and 1.5% oropharyngeal(n=3/201). Reported anal and oral sex (vs. neither) was independently associated with STI screening [aPR: 2.11 (1.05-4.27)] at PrEP initiation. At biannual PrEP-Care visits, STI screening was lower and positivity for syphilis and rectal gonorrhea/chlamydia was higher. CONCLUSIONS Observed STI screening levels and disease burden suggest the effectiveness of STI screening in PrEP care for STI prevention is not yet realized. Our results suggest providers may be offering screening based on sexual practices; clarification of STI screening guidelines for PrEP users is needed.