Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence

Templeton, David J; Read, Phillip; Varma, Rajesh; Bourne, Christopher

doi:10.1071/sh14003

Cited by 87 publications

(55 citation statements)

References 166 publications

(175 reference statements)

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“…As such, misclassification of bisexual men or MSM as heterosexual may have resulted in the small number of heterosexual males being reported as having extra-genital infection, a pattern of infection described among MSM. 5 While a high response rate maximises the internal validity of our findings, it is possible that nonresponding doctors may have been less likely to be engaged in risk factor identification, STI screening and treatment.…”

Section: Discussionmentioning

confidence: 99%

“…27 NAAT is the recommended test for all sites; however, culture is also recommended before treatment to monitor antibiotic resistance. 5,28 The small proportion of culture results notified is concerning, given global concerns about an increase in antibiotic resistance. 29 Our results suggest that clinicians require ongoing education about testing and reminders of the importance of obtaining gonococcal cultures before treatment for ongoing gonococcal surveillance.…”

Section: Discussionmentioning

confidence: 99%

“…This underscores the importance of regular and frequent asymptomatic STI testing among MSM, as recommended in national guidelines. 5 Current guidelines for asymptomatic MSM recommend gonorrhoea testing of pharyngeal and rectal swabs, and a first-void urine specimen. 5 It has been noted that while comprehensive STI testing among MSM has improved, many still do not undergo recommended tests.…”

Section: Discussionmentioning

confidence: 99%

“…5 Current guidelines for asymptomatic MSM recommend gonorrhoea testing of pharyngeal and rectal swabs, and a first-void urine specimen. 5 It has been noted that while comprehensive STI testing among MSM has improved, many still do not undergo recommended tests. 27 NAAT is the recommended test for all sites; however, culture is also recommended before treatment to monitor antibiotic resistance.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Regular testing of high-risk populations is recommended for individual and public health benefits. 5,6 In Australia, the highest notification rates in urban areas occur in MSM, although characteristics of those infected are not well described. 1,7 Australian notification rates have risen steadily since 1993, with a substantial increase in New South Wales (NSW), 1 mirroring similar increases observed in Europe and the United States since 2009.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of gonorrhoea cases notified in inner and south-western Sydney, Australia: results of population-based enhanced surveillance

et al. 2016

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Abstract. Background: Gonorrhoea disproportionately affects young people and men who have sex with men (MSM). In Australia, the highest notification rates in urban areas occur in MSM, although characteristics of those infected are poorly described. Enhanced surveillance can provide population-based data to inform service delivery and health promotion activities. Methods: An enhanced surveillance and data collection form was sent to the ordering doctor for residents of Sydney and South Western Sydney Local Health Districts with positive gonorrhoea results notified between 1 August 2013 and 28 February 2014. Results: Questionnaires were sent for 777 notifications and 698 (89.8%) were returned. Eighty-five per cent (n = 594) were male. The majority (55.1%) resided in inner city Sydney. Of these, 91.9% were male, and 70.8% of these identified as MSM. Among females, regular partners were the most likely source of infection (44.1%), while MSM and heterosexual men identified casual partners as the likely source of infection (75.4% and 61.1% respectively). General practitioners diagnosed 60.5% of cases. MSM were more commonly diagnosed by sexual health clinics. Females were most commonly tested for contact tracing (35.6%), heterosexual males because of symptoms (86.3%), and MSM as part of sexually transmissible infection screening (40.6%). Conclusions: Our population-based analysis identified differing risk factors and testing characteristics between MSM, heterosexual males and females. Increasing rates of gonorrhoea and concerns over antibiotic resistance highlight the importance of obtaining accurate sexual histories to ensure appropriate testing. Intermittent enhanced surveillance can monitor trends in specific populations and help determine the impact of health promotion strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characteristics of gonorrhoea cases notified in inner and south-western Sydney, Australia: results of population-based enhanced surveillance

et al. 2016

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Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection

Traeger

Cornelisse

Asselin

et al. 2019

JAMA

321

253

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Emerging evidence suggests that risk of bacterial sexually transmitted infections (STIs) increases among gay and bisexual men following initiation of HIV preexposure prophylaxis (PrEP). OBJECTIVE To describe STI incidence and behavioral risk factors among a cohort of predominantly gay and bisexual men who use PrEP, and to explore changes in STI incidence following PrEP commencement. DESIGN, SETTING, AND PARTICIPANTS The Pre-exposure Prophylaxis Expanded (PrEPX) Study, a multisite, open-label intervention study, was nested within the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) clinic network. A total of 4275 participants were enrolled (July 26, 2016-April 1, 2018) in Victoria, Australia. Of these, 2981 enrolled at 5 ACCESS clinics (3 primary care, 1 sexual health, and 1 community-based HIV rapid testing service), had at least 1 follow-up visit, and were monitored until April 30, 2018. EXPOSURES Upon enrollment, participants received daily oral tenofovir disoproxil fumurate and emtricitabine for HIV PrEP, quarterly HIV and STI testing, and clinical monitoring. MAIN OUTCOMES AND MEASURES The primary outcome was incidence of chlamydia, gonorrhea, or syphilis. Incidence rates and hazard ratios describing behavioral risk factors of STI diagnosis were calculated. Incidence rate ratios (IRRs), adjusted for change in testing frequency, described changes in STI incidence from 1-year preenrollment to study follow-up among participants with preenrollment testing data (n = 1378). RESULTS Among the 2981 individuals (median age, 34 years [interquartile range, 28-42]), 98.5% identified as gay or bisexual males, 29% used PrEP prior to enrollment, 89 (3%) withdrew and were censored at date of withdrawal, leaving 2892 (97.0%) enrolled at final follow-up. During a mean follow-up of 1.1 years (3185.0 person-years), 2928 STIs were diagnosed among 1427 (48%) participants (1434 chlamydia, 1242 gonorrhea, 252 syphilis). STI incidence was 91.9 per 100 person-years, with 736 participants (25%) accounting for 2237 (76%) of all STIs. Among 2058 participants with complete data for multivariable analysis, younger age, greater partner number, and group sex were associated with greater STI risk, but condom use was not. Among 1378 participants with preenrollment testing data, STI incidence increased from 69.5 per 100 person-years prior to enrollment to 98.4 per 100 person-years during follow-up (IRR, 1.41 [95% CI, 1.29-1.56]). After adjusting for testing frequency, the increase in incidence from 1 year preenrollment to follow-up was significant for any STI (adjusted IRR, 1.12 [95% CI, 1.02-1.23]) and for chlamydia (adjusted IRR, 1.17 [95% CI, 1.04-1.33]). CONCLUSIONS AND RELEVANCE Among gay and bisexual men using PrEP, STIs were highly concentrated among a subset, and receipt of PrEP after study enrollment was associated with an increased incidence of STIs compared with preenrollment. These findings highlight the importance of frequent STI testing among gay and bisexual men using PrEP.

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Caring for Men Who Have Sex with Men

Medder

2016

Men's Health in Primary Care

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Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence

Cited by 87 publications

References 166 publications

Characteristics of gonorrhoea cases notified in inner and south-western Sydney, Australia: results of population-based enhanced surveillance

Characteristics of gonorrhoea cases notified in inner and south-western Sydney, Australia: results of population-based enhanced surveillance

Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection

Caring for Men Who Have Sex with Men

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