Gaps in STI Incidence and Testing Prevail in New York City
This cross-sectional study of adults residing in New York City showed discrepancies between testing rates for sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and HIV and their incidence across demographics and socioeconomic status, potentially missing out cases among individuals who were not concurrently tested.
METHODOLOGY:
Researchers conducted a cross-sectional study to compare testing, diagnosis patterns, and sociodemographic disparities among patients with STIs, particularly chlamydia, gonorrhea, and HIV, in New York City between January 2018 and June 2023.
They analyzed 4,767,322 patients (mean age, 46 years; 61% women) from Healthix — a public health information exchange that collects data from healthcare facilities and stratified them by poverty level based on their residential area.
The primary outcomes were proportion tested and confirmed positive for chlamydia, gonorrhea, and/or HIV. The patterns of concurrent testing, coinfection, and their variation based on sociodemographic and geographic factors were also evaluated.
TAKEAWAY:
During the study period, 1,519,121 chlamydia tests, 1,574,772 gonorrhea tests, and 1,200,560 HIV tests were conducted, with positivity rates of 2%, 1%, and 0.3%, respectively.
Chlamydia and gonorrhea testing were predominantly concurrent (98% of chlamydia tests and 95% of gonorrhea tests); however, only 44% of HIV tests were conducted simultaneously with those for both chlamydia and gonorrhea.
Men were less likely than women to be tested for chlamydia (adjusted odds ratio [aOR], 0.62) and gonorrhea (aOR, 0.63), yet when tested, they had higher odds of testing positive for those infections (aOR, 1.09 and 3.28, respectively). In contrast, men had 16% higher odds of being tested for HIV and were also more likely to test positive for HIV.
Individuals residing in very high-poverty areas were less likely to be tested but more likely to test positive for all three STIs than those residing in low-poverty areas.
IN PRACTICE:
'Improving surveillance capacity may offer a more nuanced understanding of population- and neighborhood-level patterns, elucidate inequity, inform targeted intervention, and improve resource allocation,' the authors of the study wrote.
SOURCE:
This study was led by Harry Reyes Nieva, PhD, Columbia University, New York City. It was published online on June 17, 2025, in JAMA Network Open.
LIMITATIONS:
Healthix did not capture all testing conducted in New York City, and data on race and ethnicity of a substantial proportion of patients were missing. Although individuals on HIV preexposure prophylaxis typically undergo regular STI screening, the analysis approach did not fully account for its effect on the findings.
DISCLOSURES:
This study was supported by the National Institute of Allergy and Infectious Diseases and National Library of Medicine at the National Institutes of Health and a fellowship from the Association for Computing Machinery Special Interest Group in High Performance Computing. One author reported receiving grants from the study funders.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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