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  • 1.  STI screening recommendations

    Posted 01-29-2025 15:15

    Hello All,

    I have a question regarding screening for STI for PLWH who are not sexually active at all. Could we stop checking their GC and RPR as per patient request or should we continue checking them annually?



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    Rashmi Mathew, MD
    Santa Cruz, CA
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  • 2.  RE: STI screening recommendations

    Posted 01-29-2025 17:01

    Hi Rashmi,

    Many Ryan White programs require that STI screens be done annually,. regardless.    I think that a concern may be that a patient may not be completely  honest when discussing his or her sexual activity.   Therefore, it's likely best for the patient and the community to have this  done periodically.    If you say something  like "we do these screens for everyone", then it may  be easier for the patient to accept.



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    Adam Zweig
    San Diego CA
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    Original Message


  • 3.  RE: STI screening recommendations

    Posted 01-29-2025 17:22
    Edited by Rashmi Mathew 01-29-2025 17:24

    Thank you 



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    Rashmi Mathew
    Santa Cruz,  CA
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    Original Message


  • 4.  RE: STI screening recommendations

    Posted 01-30-2025 16:57

    Taking the time to get a thorough sexual history by explaining why we are asking the questions we ask, using open-ended questions, reflecting patient language, asking for clarification if a patient uses a term that we are not familiar with, being supportive and non-judgmental – this is how we build trust.  To then decide you don't believe someone and order tests anyway is a sure way to erode this trust which is the most important pillar of our therapeutic relationship.  I document the patient's explicit sexual activity and order the appropriate screening tests carefully considering when which site was last screened.

     

    Peter Meacher MD AAHIVS FAAFP (he/him)

    WPATH GEI SOC8 Certified Member

    Director of LGBTQ Care, Western Region

    130 East 77th St

    Black Hall 6th Floor, 6-205

    New York NY 10075

     

     

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    Original Message


  • 5.  RE: STI screening recommendations

    Posted 01-31-2025 17:31

    Guess I disagree.  Our RW contract requires STI screens (and HCV screening) be done at least annually and makes no provision for a patient who is not at risk.  In any case, I personally believe that periodic screening is indicated in all our patients and  does not have to erode trust.  Does screening for HIV per CDC guidelines erode trust in a patient that might not be at risk?  Not if  we are completely non judgmental and use appropriate wording.  



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    Adam Zweig
    San Diego CA
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    Original Message


  • 6.  RE: STI screening recommendations

    Posted 01-31-2025 20:28
    Edited by James Adams 01-31-2025 20:33

    Great points, Dr. Meacher, and I agree with you. I do order RPRs on everyone at least once or twice yearly (they can always refuse at the lab if they want), and urine for GC/C, and we are gonna start allowing self-swabbing, which is a positive.  I tailor the testing and swabbing to their sexual practices as well, but I do still offer swabs for anal GC/C to MSM patients who say that they are "tops."  



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    James Adams
    Rancho Mirage CA
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    Original Message


  • 7.  RE: STI screening recommendations

    Posted 01-30-2025 15:18
    A very good discussion point. The clinics I now work for were doing these screenings on essentially all the patients at their HIV follow up visits at 3 or 6 months. We have been trying to streamline this some at least based on clinical history - but we all know who challenging that can be and anecdotally have seen patients with "no sexual partners" test positive for an STI. Several years ago my Resident and I "missed" a case of secondary syphilis for a patient I had been seeing for over 10 years who was adamant about "no sex" since he and his partner had broken up several year prior. He unfortunately did not consider oral sex as having sex. When his RPR came back at 1:64 (previously negative) he was a bit surprised and angry...at himself. We will continue to regularly screen the majority of our patients unless they refuse (rare) or there would be significant push-back from payers, which also has been uncommon.   



    Original Message


  • 8.  RE: STI screening recommendations

    Posted 02-03-2025 14:42

    First of all, I'll acknowledge that this isn't the most important issue we can tackle right now, having bigger fish to fry in this country. 

    But I do think, to second Dr. Meacher's point about trust, that this is actually a great example of how stigma creeps into ostensibly evidence-based practice. Obviously, we have data to show that sexually active PLWH are at increased STI risk compared to those without HIV. But somehow, we have made the leap from this data to a mandate that all PLWH, whatever they might say about their sex lives, submit to repeated screening. Our patients put up with a lot of scrutiny of their sex lives and have internalized a lot of bad feelings about the "riskiness" of their intimate relationships. I feel like the least we can do is believe them. In my experience, allowing someone to decline unneeded STI screening is often a huge relief to them. So, I will continue to select screenings based on a thorough history, and if I must spend my energy pushing back against something, it will be against the wording of the Ryan White requirement rather than against my patients' refusals.



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    Julia Cooper MD, AAHIVS
    New York, NY
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    Original Message


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