High prevalence of gonococcal and chlamydial infection in men who have sex with men with newly diagnosed HIV infection: an opportunity for same-day presumptive treatment.

BACKGROUND: The increasing use of point-of-care HIV tests in sexually transmitted disease (STD) clinics allows for rapid identification of patients with newly diagnosed HIV infection who may also be at risk for more common sexually transmitted infections. Positive point-of-care HIV test results might be used to identify and provide presumptive treatment to patients who are likely to be coinfected with gonorrhea (GC) and chlamydia (CT).
METHODS: Data from 6864 STD clinic visits by men who have sex with men (MSM) with no history of HIV infection and an HIV antibody test at that visit were analyzed. Results from rectal, pharyngeal, and urine nucleic acid amplification tests were used to calculate the prevalence of infection with GC and CT.
RESULTS: MSM with newly diagnosed HIV infection were more likely than HIV-uninfected MSM to be infected with GC (25.9% [53 of 205] vs. 10.9% [728 of 6659]; P < 0.001) and CT (18.5% [38 of 205] vs. 7.8% [518 of 6659]; P < 0.001).
CONCLUSIONS: GC and CT are common in MSM with newly diagnosed HIV infection at an STD clinic. In this population, a positive point-of-care HIV test result is a useful risk marker for untreated gonococcal and chlamydial infections and provides a justification for presumptive GC and CT treatment.