1. Bacterial STI Screening in An Inner city HIV Clinic Adetunji Adejumo, MD; Cynthia Lee MA; Sharon Mannheimer, MD Department of Medicine, Division of Infectious Disease, Harlem Hospital Center, Columbia University,New York, New York. Sexually transmitted infections (STIs) can serve as cofactors for HIV transmission. In this report we describe the incidence of bacterial STIs identified through a screening program conducted among HIV-infected individuals attending an inner city adult Infectious Diseases clinic from April 2007 through November 2008. 1.Wafaar El-Sadr, MD. Division of Infectious Disease, Harlem Hospital Center, New York, NY10037 2.Vel Sivapalan. Fellowship Program Director, Division of Infectious Disease, Harlem Hospital Center, New York, NY10037 3. Beverly Justiniano. HIV Co-Factor program. Infectious Disease Clinic, Harlem Hospital Center, New York, NY10037 1., Manning SE, Pfeiffer MR, Nash D,, Et al. Incident sexually transmitted infections among persons living with diagnosed HIV/AIDS in New York City, 2001-2002: a population-based assessment. Sex Transm Dis. 2007; 34(12):1008-15. 2. Catchpole MA, Mercey DE, Nicoll A, Et al., Continuing transmission of sexually transmitted diseases among patients infected with HIV-1 attending genitourinary medicine clinics in England and Wales. BMJ 1996; 312(7030):539-42. 3. Czelusta A, Yen-Moore A, Van der Straten M, Et al. An overview of sexually transmitted diseases. Part III. Sexually transmitted diseases in HIV-infected patients. J Am Acad Dermatol. 2000; 43(3): 409-32 4. Marrazzo J: Syphilis and other sexually transmitted diseases in HIV infection. Top HIV Med. 2007; 15(1): 11-6. 5. Dougan S, Evans BG, Elford J. Sexually transmitted infections in Western Europe among HIV-positive men who have sex with men. Sex Transm Dis. 2007; 34 (10): 783-90 6. Sangani P, Rutherford G, Wilkinson D. Population-based interventions for reducing sexually transmitted infections, including HIV infection. Cochrane Database Syst Rev. 2004; (2):CD001220. 7. Rieg G, Lewis RJ, Miller LG, Et al., Asymptomatic sexually transmitted infections in HIV-infected men who have sex with men: prevalence, incidence, predictors, and screening strategies. AIDS Patient Care STDS. 2008; 22 (12): 947-54 8. Mimiaga MJ, Mayer KH, Reisner SL, Et al., Asymptomatic gonorrhea and chlamydial infections detected by nucleic acid amplification tests among Boston area men who have sex with men. Sex Transm Dis. 2008; 35:495-8 Under the Co-factors program, funded by the New York City Department of Health and Mental Hygiene (NYC DOHMH), screening for bacterial STIs was implemented in the Harlem Hospital adult Infectious Diseases clinic in April 2007. The clinic provides HIV primary care to approximately 750 HIV- infected adult patients with 47% women, 83% Blacks, 14% Latinos. Background Setting Conclusion Bibliography Acknowledgments Results Contact Information Adetunji Adejumo, MD. ID Clinical Fellow Department of Medicine,Division of Infectious Disease Harlem Hospital Center/Columbia University 506 Lenox Avenue,New York, NY 10037. Email:aa2453@columbia.edu Screening was done for Neisseria gonorrhea (GC), chlamydia trachomatis (CT), and Treponema pallidum (syphilis).GC/CT screening was performed on urine by amplified DNA assay (BD ProbeTec™; Bacton, Dickson and Company, Sparks, MD). Syphilis testing was done by IgG antibody with reflex testing of positive specimens for rapid plasma reagin (RPR)/microhemagglutination assay Treponema pallidum (MHATP). Patients with positive test results were referred for STI treatment. All received safe sex counseling. Method A total of 1248 specimens for bacterial STIs were collected from 793 adult HIV-infected patients ( ≥ 18yrs) between April 2007- November 2008 and consisted of 53% men and 47% women with a mean age of 45 y (range 18- 84). Urine GC/CT testing was done on 217 (27.3%) patients. 5 (2.3% of 217 patients; 3 women, 2 men) were positive for GC/CT with 4 of 5 positive for GC and 2 of 5 positive for CT. 1 of 5 tested positive for both GC/CT. Among the 5 positive for GC/CT mean age was 30.5 y (range 18- 48). Among the 212 patients who tested negative for GC/CT, 66% were men; mean age was 45 y (range 18-77). Only 2 of 5 patients with positive GC/CT reported symptoms, and both were MSM (ages 19 and 35). Syphilis testing was performed on 780 patients, of whom 26.4% (206/780) tested positive. For the 206 adults (59% men, 41% women) with positive IgG serology for syphilis, mean age was 48 y (range 19-84) and for those with negative IgG serology (50% men) the mean age was 46 y (range 18- 78). Of the 206 with positive syphilis IgG serology, 168 patients (81.5%) had a reactive MHATP, 61 patients (29.6%) had a reactive RPR. The 61 patients with a reactive RPR included 39 men (64%) and 22 women (36%); mean age was 44 y (range 19-77). None presented with symptoms associated with syphilis. Between April 2007 and November 2008, two percent of HIV infected inner city population had GC/CT infection detected by urine testing. Eight percent had a reactive RPR for syphilis. Patient with GC/CT were younger compared to patients who tested negative and those with evidence of syphilis. Screening for bacterial STIs in this inner city HIV clinic identified asymptomatic STIs, supporting screening and treatment as one strategy for secondary HIV prevention. 793 HIV Infected Adults (53%Male; 47% Female 217 GC/CT DNA Probe780 Syphilis Serology 5 (2.3%) Positive 212 Negative 574 Negative 206 (26.4%) Positive Ig G 4 +GC 2 +CT 1 +GC/CT 168 (21.5%) +MHATP 61 (8%) +RPR Flow Chart of Patients Tested and Results ss Pathogen (Number)NUMBER POSTIVE % of Total Tested N. gonorrhea/ C. trachomatis (n = 217) 5 (mean age 30.5 y) 2.3% T. Pallidum (n = 780)61 (mean age 44.0 y) 8% Teaching Point High risk behaviors including unsafe sexual practices appear to be more common in the HIV population. Asymptomatic bacterial STD is more prevalent than previously thought in this cohort. Screening and treatment of bacterial STI is an essential component of the strategy to prevent HIV transmission. Safe sex counseling, routine STI screening even when asymptomatic, treatment and partner services is now been recommended by the Center for Disease Control (CDC) as part of standard of care for HIV infected patients.