Many STIs Not Detected In U.S. Because Of Lack Of Testing Among MSM, Health Officials Say

Main Category: Sexual Health / STDs
Also Included In: HIV / AIDS;  Men's health
Article Date: 17 Mar 2008 - 5:00 PDT

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Many cases of sexually transmitted infections are not being detected in the U.S. because of a lack of testing among men who have sex with men, health officials said Wednesday at a scientific meeting in Chicago, the New York Times reports. According to health officials, MSM are not being tested for STIs annually as advised, and some physicians and clinics are not following screening recommendations. CDC recommends annual blood tests for HIV and syphilis, and other tests for gonorrhea and chlamydia, the Times reports.

Three studies conducted by CDC researchers and presented at the meeting showed that screening rates were too low, the Times reports. A study conducted by Kristen Mahle found that among MSM who showed no symptoms of gonorrhea, more than one-third of rectal gonorrhea infections, as well as one-fourth of throat infections, were missed because some physicians did not test all anatomical sites of recent exposure. Gonorrhea tests should include specimens from all potential exposure sites, the Times reports. In addition, Eric Tai, who surveyed HIV-negative MSM in 15 U.S. cities from 2003 to 2005, found that 39% reported having been tested for syphilis and that 36% reported having been tested for gonorrhea. Karen Hoover found that although physicians tested 82% of HIV-positive MSM in eight U.S. cities for syphilis in 2005, the researchers tested 22% or fewer MSM for gonorrhea and chlamydia.

According to the Times, one issue is that health departments administering sexual disease clinics lack adequate staffs and funding to conduct comprehensive testing. John Douglas, director of CDC's Division of Sexually Transmitted Diseases Prevention, said, "Let's be honest, resources are a challenge at a federal, state and local level." He added, "We are trying to be as innovative as we can with public health resources," but "we need help from others." Health officials and researchers at the meeting said that more STI cases could be detected if the government approved new ways to use a DNA test, called NAAT. They added that the test can detect twice as many cases of gonorrhea and chlamydia in the throat and rectum, compared with standard tests. FDA has approved three NAATs to screen for gonorrhea and chlamydia in the genitalia but not the throat or rectum (Altman, New York Times, 3/13).

U.S. Syphilis Rates Increase for Seventh Consecutive Year, CDC Says
In related news, CDC on Wednesday at the meeting announced that the U.S. syphilis rate in 2007 increased for the seventh consecutive year, Reuters reports. According to preliminary data from CDC, the overall national rate of syphilis in 2007 increased by 16%, from 9,756 cases in 2006 to 11,181 cases in 2007. MSM accounted for 64% of the new cases in 2007, CDC said, adding that men accounted for six times as many cases as women. According to CDC, the black community also was highly affected, with rates seven times higher for men and 14 times higher for women when compared with whites.

CDC officials expressed concern about the increase because syphilis can raise the risk of HIV. "Having multiple sex partners and other high-risk behaviors like not using condoms do put [people] at higher risk for HIV and syphilis," Hillard Weinstock, a CDC epidemiologist, said. He added, "Syphilis can increase the likelihood of HIV transmission two to fivefold. And CDC recommends that sexually active MSM get tested for syphilis, HIV and other [STIs] at least annually."

Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- said, "It is imperative that we make [STI] screening and treatment a central part of the medical care for" MSM, as well as finding new ways to curb the spread of STIs (Dunham, Reuters, 3/12).

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