Background: The CDC Advisory Committee for HIV/STD Prevention recommends routine STD screening of asymptomatic persons infected with HIV although there is scant data to support this screening among HIV-infected men. Our study objectives were to evaluate, over a 5-month period, the prevalence of asymptomatic gonorrhea (GC) and Chlamydia (CH) infections among HIV⁺ males attending a university-based outpatient clinic, identify risk factors for the development of these STDs, and evaluate the cost effectiveness of routine STD screening of asymptomatic individuals.

Methods: Retrospective analysis, via chart review.

Results: Of the 403 men seen, 245 (61%) were offered screening. By subject report, 68 (28%) were abstinent, 88 (36%) used condoms consistently, 10 (4%) had unprotected vaginal sex, 7 (3%) had unprotected anal sex, 8 (3%) had unprotected oral sex, 16 (7%) had a combination of unprotected oral, anal and/or vaginal sex, and 48 (20%) did not provide a sexual history. Eleven (11)/245 (5%, 95% CI, 4%–6%) were found to be positive for a STD (5 cases of GC, 7 of CH (2 patients had both) and one trichomoniasis). The mean age was 40 ±0.6 in subjects with no STDs vs 27 ±2 in subjects with STDs (p < 0.001). Heterosexuals were more likely to have STDs (10.3% vs 3.2%, p = 0.1).The rates of unprotected sex (anal, vaginal, or oral) between patients with or without STDs were similar. There were no significant differences in STD rates between African American and Caucasians (5% vs 4.2%, p NS). The RR of STDs in subjects with history of illicit drug use was 8.8 (11.9% vs 1.9%, p = 0.005). CD4⁺ T-cell counts were similar between both groups (371 ±21 vs 290 ±99, p NS). Median VL was lower among subjects with no STDs (674 vs 41750, p = 0.02).

Conclusions: Five percent (5%) of the men screened were found to have an asymptomatic STD. In spite of ongoing education 1/5 of the men reported unprotected sexual activity. In our clinic population, STDs were more common in younger heterosexual men with a history of illicit drug use and a detectable viral load. Since urethral shedding of HIV is amplified by the presence of concurrent STDs and associated with an increased risk of transmission, the treatment of asymptomatic individuals might result in a decreased risk of HIV transmission and be a cost-effective harm reduction strategy. Our findings support the CDC recommendations to screen periodically for STDs all asymptomatic HIV⁺ men.