Behavioral Determinants of Asymptomatic Chlamydia and Gonorrhea Among People Living With HIV in Thailand: A Cross-sectional Study

Asymptomatic sexually transmitted infections (STIs), particularly Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), remain common among people living with HIV (PLHIV). To determine the prevalence of asymptomatic CT/NG infections and identify associated behavioral factors among PLHIV using Pender's Health Promotion Model, our cross-sectional study included 657 asymptomatic PLHIV enrolled in an ongoing cohort at a HIV research center in Bangkok, Thailand. Participants underwent CT/NG nucleic acid amplification testing and completed behavioral questionnaires. Modified Poisson regression estimated adjusted prevalence ratios. CT-only, NG-only, and dual CT/NG infections were identified in 12.2%, 6.8%, and 3.0% of participants, respectively. Overall, 16.0% had at least one asymptomatic infection. Younger age, prior STI history, and condom slippage were associated with CT/NG infection, whereas younger age and injection drug use were associated with dual infection. Routine extragenital STI screening and behavioral risk assessment should be integrated into HIV care.