Should a low prevalence of asymptomatic Chlamydia trachomatis infection in gay men attending HIV clinics discourage from opportunistic screening?

Genitourinary (GU) medicine notifications for homosexually acquired Chlamydia trachomatis (CT) infections show a 414% increase from 1996 to 2002. However, little is known about the prevalence of CT in men who have sex with men (MSM) outside GU medicine settings. Behavioural studies show that MSM with diagnosed HIV infection continue to engage in high-risk sexual behaviour with the risk for sexually transmitted infections (STI) acquisition and HIV transmission. This study analysed the results of urine-based CT screening in MSM attending a London HIV clinic in order to inform local policy on the benefit and patients' acceptability of opportunistic screening. Among men screened, 1.9% (2/107) had asymptomatic CT infection. Screening was well accepted and practical to be implemented in the clinic routine. It is unclear whether isolated routine urine screening is cost effective in the context of HIV prevention. HIV clinics should incorporate a public health perspective and actively contribute to HIV prevention by addressing sexual health and scope opportunities for STI screening.