Sexually Transmitted Infection (STI) Testing for People with HIV

Measure Specification

In 2024, the combined total number of cases of chlamydia, gonorrhea, and syphilis declined 9% from 2023, down a third consecutive year. There were still more than 2.2 million reported STIs in 2024, and compared to a decade ago, overall cases are 13% higher; congenital syphilis is nearly 700% higher. CDC data from 2023 indicates that 46% of people with HIV were tested for chlamydia, gonorrhea, and syphilis in the 12-month period.

In 2022, men who have sex with men accounted for 45% of all make primary and secondar syphilis and approximately 36% of men who have sex with men with primary and secondary syphilis also had HIV. Chlamydia and gonorrhea infections among women can result in pelvic inflammatory disease, ectopic pregnancy, and infertility. This measure will help providers focus their attention and quality improvement efforts towards testing and treating sexually transmitted infections in patients with HIV, thus reducing the complications to long-term syphilis infection and reducing STI incidence.

"At the initial HIV care visit, providers should screen all sexually active persons for syphilis, gonorrhea, and chlamydia, and perform screening for these infections at least annually during the course of HIV care. Specific testing includes syphilis serology and nucleic acid amplification test (NAAT) for N. gonorrhoeae and C. trachomatis at the anatomic site of exposure….

More frequent screening for syphilis, gonorrhea, and chlamydia (e.g., every 3 or 6 months) should be tailored to individual risk behavior and the local prevalence of specific STIs. “Rectal and pharyngeal testing by NAAT for gonorrhea and chlamydia is recognized as an important sexual health consideration for [men who have sex with men] MSM…. Pharyngeal infections with gonorrhea or chlamydia might be a principal source of urethral infections….

Approximately 70% of gonococcal and chlamydial infections might be missed if urogenital-only testing is performed among [men who have sex with men] MSM because most pharyngeal and rectal infections are asymptomatic. Self-collected swabs have been reported to be an acceptable means of collection for pharyngeal and rectal specimens, which can enhance patient comfort and reduce clinical workloads.

“For women, C. trachomatis urogenital infection can be diagnosed by vaginal or cervical swabs or first-void urine. For men, C. trachomatis urethral infection can be diagnosed by testing first-void urine or a urethral swab. NAATs are the most sensitive tests for these specimens and are the recommended test for detecting C. trachomatis infection. NAATs that are FDA cleared for use with vaginal swab specimens can be collected by a clinician or patient in a clinical setting.

Patient- collected vaginal swab specimens are equivalent in sensitivity and specificity to those collected by a clinician using NAATs, and this screening strategy is highly acceptable among women. “Recent studies have demonstrated that among men, NAAT performance on self-collected meatal swabs is comparable to patient-collected urine or provider-collected urethral swabs.

Patient collection of a meatal swab for C. trachomatis testing might be a reasonable approach for men who are either unable to provide urine or prefer to collect their own meatal swab over providing urine. “Rectal and oropharyngeal C. trachomatis infection among persons engaging in receptive anal or oral intercourse can be diagnosed by testing at the anatomic exposure site….

Data indicate that NAAT performance on self-collected rectal swabs is comparable to clinician-collected rectal swabs, and this specimen collection strategy for rectal C. trachomatis screening is highly acceptable among men. Self-collected rectal swabs are a reasonable alternative to clinician-collected rectal swabs for C. trachomatis screening by NAAT, especially when clinicians are not available or when self-collection is preferred over clinician collection.

Annual screening for rectal C. trachomatis infection should be performed among men who report sexual activity at the rectal site. Extragenital chlamydial testing at the rectal site can be considered for females on the basis of reported sexual behaviors and exposure through shared clinical decision-making by the patient and the provider. The majority of persons with C.

trachomatis detected at oropharyngeal sites do not have oropharyngeal symptoms.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.