{
  "abstract": "Background Sexually transmitted infections (STIs) are important markers of HIV acquisition risk and provide key opportunities for HIV testing and diagnosis. However, real-world data describing HIV serostatus, testing coverage, newly diagnosed and known HIV infection across specific STI diagnoses remain scarce.Material and Methods We conducted a retrospective analysis of all STI cases diagnosed at an urban referral centre over three decades. For each STI case, the known HIV-positive status at presentation, HIV test result at time of STI diagnosis, and newly identified HIV infection were available.Results From January 1991 to December 2023, 17,771 STI cases were recorded. Overall, an HIV test result was available for 8,299 (46.7%) patients; 829 of these were previously known to be people living with HIV (PLWH), and 7,470 underwent HIV testing at the time of STI diagnosis. The proportion of cases with known HIV infection at presentation varied substantially by STI, ranging from 33.3% for lymphogranuloma venereum, 16.0% for infectious syphilis (primary, secondary and early latent) and 14.6% for late latent syphilis, to 1.4% for anogenital warts and <1.0% for non-gonococcal non-chlamydial urethritis and vaginitis. Overall, HIV period prevalence was 12.3% (1,023/8,299; 95% CI: 11.6–13.0) and differed markedly across STIs: from 45.5% (5/11; 95% CI: 19.8–70.2) in lymphogranuloma venereum, 25.1% (136/542; 95% CI: 21.4–28.7), in latent syphilis, 22.3% (472/2,121; 95% CI: 20.5–24.9) in infectious syphilis, to 6.2% (196/3,238; 95% CI: 5.4–7.0) in anogenital warts, 3.8% (22/584; 95% CI: 2.2–5.3) in genital herpes, 3.0% (6/202; 95% CI: 0.6–5.3) in non-gonococcal non-chlamydial urethritis, and 1.6% (3/190; 95% CI: undetermined) in non-gonococcal non-chlamydial vaginitis. Among cases tested at the time of STI diagnosis, the highest proportions of new HIV diagnoses were observed in latent syphilis (4.9%). HIV testing coverage varied widely across STIs, with higher coverage in syphilis, gonorrhoea, lymphogranuloma venereum, and genital herpes (median tested:72.9%; IQR 69.0–73.3), and lower coverage in anogenital warts and molluscum contagiosum (median tested 28.1%; IQR 23.9–30.2).Conclusions STI diagnoses are associated with a heterogeneous yet often substantial HIV burden, partly driven by a high proportion of PLWH within STI case series. Although HIV testing coverage is higher for STIs most strongly linked to HIV acquisition risk, a considerable proportion of patients remain unaware of their serostatus at the time of STI diagnosis, representing missed opportunities for timely HIV detection. These findings are consistent with data from the Italian STI Sentinel Surveillance System and likely reflect a broader, system-level gap rather than a local anomaly. In line with recommendations from other European settings, opt-out HIV testing should be systematically implemented for all STI diagnoses, including those traditionally considered to be at lower risk.",
  "authors": [
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "M Giuliani"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "C Stingone"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "L Gianserra"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "M Zaccarelli"
    },
    {
      "affiliations": [
        "Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy"
      ],
      "name": "F Pimpinelli"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "MG Donà"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "E Giuliani"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "F Di Tullio"
    },
    {
      "affiliations": [
        "STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy"
      ],
      "name": "A Latini"
    }
  ],
  "title": "OC32 HIV burden and testing patterns among patients with sexually transmitted infections: a 30-year real-world analysis",
  "uid": "69658783-b59f-506b-a4f6-17f133e1e3f3"
}