Factors Associated With Early Resumption of Condomless Anal Sex Among Men Who Have Sex With Men After Rectal Chlamydia Treatment

Abstract

Background The resumption of sexual activity shortly after commencing treatment for sexually transmitted infections (STIs) is poorly described despite contributing to onward transmission. With azithromycin remaining an option for rectal Chlamydia trachomatis, resuming sex too early after treatment may contribute to antimicrobial resistance because of exposure of newly acquired STIs to subinhibitory concentrations. Methods Clinical and sexual behavioral data were collected from men participating in a trial assessing treatment efficacy for rectal chlamydia. Data were collected at recruitment and weekly for 3 weeks after commencing treatment. Outcome measures were resumption of any sexual activity or condomless receptive anal sex within 1, 2, or 3 weeks after commencing treatment. Generalized linear regression was used to calculate adjusted risk ratios (aRR) to identify associated factors. Results Almost 1 in 10 men (9.5%; 95% confidence interval [CI], 7.2–12.1) resumed condomless receptive anal sex within 1 week of commencing treatment. This was associated with current preexposure prophylaxis use (aRR, 3.4; 95% CI, 2.5–4.8]) and having 9 or more sexual partners in the last 3 months (aRR, 3.2; 95% CI, 1.6–5.0). Most men (75.0%; 95% CI, 71.3–78.5) resumed any sexual activity within 3 weeks; this was associated with a greater number of sexual partners (4–8 partners; aRR, 1.2; 95% CI, 1.1–1.5; ≥9 partners; aRR, 1.5; 95% CI, 1.3–1.7). Conclusions Resuming condomless receptive anal sex early after treatment may facilitate onward transmission and promote antimicrobial resistance for STIs. Although azithromycin remains a treatment option, this analysis highlights the need for new health promotion messages regarding early resumption of sex and continued surveillance for antimicrobial resistance.

An open-label, parallel-group, randomised controlled trial of antiseptic mouthwash versus antibiotics for oropharyngeal gonorrhoea treatment (OMEGA2)

“…Most men expressed they preferred the antibiotics treatment rather than the mouthwash use and they did not want to abstain from sex and kissing for 14 days, suggesting sexual abstinence for 14 days is not acceptable. This is consistent with an Australian study showing 10% of MSM resumed sex within a week after treating for anorectal chlamydia although these men were advised to abstain from sex for 7 days after treatment 24 . Third, overestimation of the treatment effect might have occurred due to early stopping of this trial 25,26 .…”

Managing contacts of chlamydia: should clinics implement a test and wait process?

“…[20][21][22][23] There are further risks of onwards transmission of untreated chlamydia from a cohort with high infection prevalence. Studies have demonstrated that high partner numbers may be associated with an early return to sex after treatment for chlamydia, 24 and although contacts in our study had a mean of 1.9 partners in the previous 3 months, the range included up to 25 partners. Rapid partner treatment has been shown to reduce reinfection of the index case, but modelling suggests that even a 3-day delay in partner treatment after treatment of the index case results in a 4.2% probability of reinfection.…”