Retrospective study of the effect of enhanced systematic sexually transmitted infection screening, facilitated by the use of electronic patient records, in an HIV-infected cohort


Correspondence: Dr Gary Brook, Patrick Clements Clinic, Central Middlesex Hospital, Acton Lane, London NW10 7NS, UK. Tel: +44 0 208 453 2727; fax: +44 0 208 453 2224; e-mail:



The aim of the study was to assess the impact of electronic checklists in enhancing sexually transmitted infection (STI) screening in routine HIV care.


This was a retrospective cohort study. In two HIV clinics, new STIs were recorded for three consecutive 12-month periods between 2009 and 2012 in a cohort of 882 HIV-infected patients. These three years coincided with the introduction of enhanced STI screening based on prompts within the electronic patient record (EPR) system.


The number of diagnoses and the incidence of STIs more than doubled between 2010–2011 and 2011–2012 in both men who have sex with men (MSM) [from 18 of 115 (15%) to 42 of 132 (32%), a rise in STI incidence from 15.6 to 31.8/100 person-years; P < 0.001] and heterosexual patients [from six of 716 (0.8%) to 19 of 749 (2.5%), a rise in STI incidence from 0.8 to 2.5/100 person-years; P < 0.005]. The rise was significant in MSM for infections with chlamydia [from seven of 115 (6%) to 14 of 132 (11%), a rise in incidence from 6.0 to 10.6/100 person-years; P < 0.05], gonorrhoea [from five of 115 (4%) to 12 of 132 (9%), a rise in STI incidence from 4.3 to 9.1/100 person-years; P < 0.05] and early syphilis [from four of 115 (3%) to 13 of 132 (10%), a rise in incidence from 3.5 to 9.8/100 person-years; P < 0.001], but not for hepatitis C virus (HCV) and Lymphogranuloma venereum (LGV) infections. The rise was significant in heterosexual patients for infection with chlamydia [from four of 716 (0.6%) to 13 of 749 (1.7%), a rise in incidence from 0.6 to 1.7/100 person-years; P < 0.0001] but not for gonorrhoea, syphilis or Trichomonas vaginalis (TV).


These data show that implementing systematic, frequent and routine STI screening led to a large increase in detected STIs in this HIV-infected cohort. This process is greatly enhanced by the use EPRs.