Disclosures: The authors report no relevant financial disclosures.
February 25, 2021
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Many transgender women with HIV are not tested for STIs, analysis finds

Disclosures: The authors report no relevant financial disclosures.
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Despite national guidelines recommending that sexually active people with HIV be tested annually for STIs, many transgender women with HIV are not tested for syphilis, chlamydia or gonorrhea, researchers reported.

Writing in Clinical Infectious Diseases, Katy Town, PhD, an epidemiologist in the CDC’s Division of STD Prevention, and colleagues said most transgender women with HIV are engaged in care, but “clinicians may not be taking appropriate sexual behavior histories in a manner that enables patients to feel safe and comfortable to discuss their sexual practices, which may indicate the need for STI testing.”

Katy Town pullquote

“A sexual history should be included as a standard aspect of clinical care to ensure all people who may be at increased risk for STIs are getting appropriate care, including screening for syphilis, chlamydia and gonorrhea,” Town told Healio.

“It’s important for clinicians to take appropriate sexual behavior histories in a manner that enables all patients to feel safe and comfortable to discuss their sexual practices,” Town continued. “To improve the delivery and uptake of these services, clinicians may benefit from education and cultural competence training related to the appropriate care and clinical management of transgender patients.”

Town and colleagues used data from the Medical Monitoring Project, a CDC-supported HIV surveillance system, to examine rates of STI testing among 217 transgender women with HIV.

Results showed that just 47.7% (95% CI, 39.4%-56.1%) of transgender women were tested for chlamydia and 46.5% (95% CI, 38.2%-54.8%) were tested for gonorrhea within the past year. Additionally, just 64.7% (95% CI, 56.8%-72.6%) were tested for syphilis within the past 12 months and only 42.8% (95% CI, 34.8%-51.1%) of the participants were tested for all three STIs.

The study’s major limitations were an inability to examine STI diagnoses and a lack of STI screening data from providers outside each patient’s normal source of care, Town said. She noted that existing literature on STI burden and screening in transgender women is “sparse,” and that this study’s limitations are in alignment with the few other existing articles on the topic.

Still, Town said the low testing rates were “concerning.”

“There is an opportunity to increase STI testing among transgender women with HIV by implementing STI testing within routine HIV care visits,” she said.