The Effect of Using a Standardized Questionnaire on Sexual History Documentation and Testing to Diagnose Gonorrhea and Chlamydia Among Men Who Have Sex With Men With Human Immunodeficiency Virus

Most Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) infections in men who have sex with men (MSM) are diagnosed at extragenital sites. However, testing at these sites is often lacking. The purpose of this study was to determine if a standardized questionnaire administered by physicians and clinical assistants improves documentation of sex activity and increases extragenital testing and diagnoses of GC and CT among MSM.

A standardized sexual history questionnaire was implemented on 11/1/2022. Electronic medical records of 664 MSM with human immunodeficiency virus, including 1064 encounters, were reviewed to compare preimplementation and postimplementation sexual history documentation, adequacy of documentation, extragenital GC and CT testing, and GC and CT diagnoses. Analysis included χ 2 and exact tests and logistic regression adjusting for physician cluster effects.

The standardized questionnaire was used by 53.7% of physicians and 85.9% of coordinators. Documentation of whether sexual activity occurred increased from 79.3% (95% confidence interval [CI], 0.758-0.828) in the preintervention pre-COVID-19 period to 95.2% (95% CI, 0.925-0.970) in the postintervention period with an adjusted odds ratio of 4.7 (95% CI, 2.7-8.8). Specific questions about anal and oral sex increased from 42.0% to 88.1% ( P < 0.001) and 23.7% to 88.7% ( P < 0.001), respectively. Anal and pharyngeal testing increased from 14.4% to 20.2% ( P = 0.040) and 17.2% to 23.3% ( P = 0.045), respectively.

This study demonstrates that using a standardized questionnaire during clinical encounters can improve documentation of sexual activity and testing for GC and CT at extragenital sites.