Once Is Not Enough: Re-screening Sexually Transmitted Disease (STD) Clinic Patients in Six Months to Detect New STDs Once Is Not Enough: Re-screening Sexually Transmitted Disease (STD) Clinic Patients in Six Months to Detect New STDs Bolu, Omotayo 1 ; Lindsey, C 1 ; Peterman, T 1 ; Kamb, M 1 ; Bolan, G 2 ; Zenilman, J 3 ; Douglas, J 4 ; Malotte K 5 ; Rogers J 6, for the Project RESPECT study group 1 Division HIV/AIDS Prevention, CDC, Atlanta, Georgia 2 San Francisco Health Department 3 Baltimore City Health Department & Johns Hopkins University 4 Denver Public Health, Colorado Department of Health and Environ. 5 Long Beach Health Department and California State University 6 New Jersey Health Department (Trenton) & Newark STD Clinic

Background and Objectives

STD clinic patients : -Are at risk for new STDs -Do not always return to the clinic when they have a new infection since many STDs are - asymptomatic - unrecognized Question: - Should STD clinic patients return in 6 months for re- screening because they may have a new STD ?

Objectives Determine : 1. What percentage of STDs would be missed if STD clinic patients are not scheduled for follow-up visit 2. Which STD clinic patients should be scheduled for follow-up visit

Methods

Project RESPECT Arm Arm Arm Cities: Baltimore, Denver, Newark, Long Beach, San Francisco Participants: Heterosexual STD clinic patients; > 14 years; HIV - Arm participants 4328 had 6-month scheduled appointment (Days after baseline) No scheduled visit All participants: Return anytime for STD exam New STDs: Gonorrhea, Chlamydia, Syphilis, HIV

Participants divided into two groups: -Scheduled follow-up: Arms 1, 2, & 3(N=4328) -No scheduled follow-up: Arm 4 (N=1430) - Arm 4 (N=1430) x (N=4328) (to adjust for group size) The number of new STDs diagnosed in both groups over the entire 6-month study period were counted

To estimate STDs that would have been missed if clients were not scheduled for 6-month (days after baseline) follow-up visit: - New STDs in __ New STDs in Scheduled group unscheduled group Subgroup analysis: identified predictors for STDs that would have been missed if no scheduled follow-up visit

Results

6 month period

During the 6 month scheduled period (Days ): – 238 new STDs : 56% chlamydia (CT); 31% gonorrhea (GC); 8% CT & GC; 4% syphilis; 0.5% GC,CT & syphilis; 0.5% HIV – Scheduled follow-up : 2709 (63%) returned 202 new STDs – No scheduled follow-up : 36 new STDs 166 new STDs would have been missed if no scheduled visit. 6% (166/2709) of those returning had new STDs

PredictorsSTD incidenceRR (95%CI), P-value Baseline STD Yes No Age (years) > 25 Gender Female Male City Newark Baltimore Denver Long Beach San Francisco (2.4–4.6), < Ref 1.7(1.2–2.2), <0.001 Ref 0.9(0.8–1.3), 0.78 Ref 3.6(2.2–5.9), < (1.2–3.6), (1.0–2.8), (1.0–2.3), 0.05 Ref Predictors for Missed STDs

Percentages of new STDs at 6 months among persons with baseline STD by site Site All persons % Persons with baseline STD % Newark Baltimore Denver Long Beach San Francisco

Summary of Results Of those returning in the scheduled group, 6% had a new STD that would have been missed if there was no scheduled visit The main predictor is having a baseline STD: 12% had a new STD

Limitation Diagnostic test for chlamydia in the unscheduled group was less sensitive and may have underestimated the number of new STDs in this group

Conclusions 6% of STD clinic patients had a new STD, which would have been missed if they were not scheduled for a visit. The main predictor : Baseline STD (12%) Recommendation Persons with baseline STD should be asked to return for re-screening at six months because many would have a new STD

Tests performed OrganismTests performed GC CT Syphilis HIV Culture for women and men or gram stain for men PCR endocervical swab in women, Urine in men Hx, P/E, + supportive treponemal and nontreponemal antibody test Repeated EIA

Calculating Predictors Chara- cteristics Number returning ScheduledUnscheduledMissed STDs (%) Baseline STD /692 (11.9) NO STD /2017 (4)