New Human Immunodeficiency Virus Diagnosis Independently Associated With Rectal Gonorrhea and Chlamydia in Men Who Have Sex With Men

Abstract

Summary Rectal gonorrhea and chlamydia increase the risk of a new diagnosis of HIV independent of rectal sexual behavior among men who have sex with men. Background Rectal sexually transmitted infections (STI) have been associated with HIV diagnosis, but inferring a causal association requires disentangling them from receptive anal intercourse (RAI). Methods We conducted a stratified case-control study by frequency matching 4 controls to each case within year using clinical data from men who have sex with men (MSM) attending the Seattle STD Clinic 2001–2014. Cases were MSM with a new HIV diagnosis and negative HIV test ≤12 months. Controls were HIV-negative MSM. All included men had rectal STI testing, tested negative for syphilis, and had complete sexual behavior data. We categorized men by RAI: (1) none; (2) condoms for all RAI; (3) condomless RAI (CRAI) only with HIV-negative partners; and (4) CRAI with HIV-positive or unknown-status partners. We created three logistic regression models: (1) three univariate models of concurrent rectal gonorrhea, rectal chlamydia, and rectal STI in ≤12 months with new HIV diagnosis; (2) those three infections, plus age, race, year, number of sexual partners ≤2 months, and methamphetamine use; and (3) model 2 with RAI categories. We calculated the population attributable risk of rectal STI on HIV diagnoses. Results Among 176 cases and 704 controls, rectal gonorrhea, chlamydia and rectal STI ≤12 months were associated with HIV diagnosis. The magnitude of these associations attenuated in the second model, but persisted in model 3 (gonorrhea aOR 2.3 95%CI 1.3 – 3.8; chlamydia aOR 2.5 95%CI 1.5 – 4.3; prior STI aOR 3.0 95%CI 1.5 – 6.2). One in 7 HIV diagnoses can be attributed to rectal STI. Conclusion Rectal STI are independently associated with HIV acquisition. These findings support the hypothesis that rectal STI play a biologically-mediated causal role in HIV acquisition and support screening/treatment of STI for HIV prevention.

Anal Ureaplasma spp. positivity among HIV positive men who have sex with men may be associated with high-risk-type HPV infections

“…has significantly been associated with non-gonoccocal urethritis and chronic prostatitis proving that it is more than just a harmless commensal (de Cordova et al, 2016;Povlsen et al, 2002;Wetmore et al, 2011). Here, HIV positive men who have sex with men (MSM) are affected by an increasing incidence of sexually transmitted infections (STIs) (Kirby, 2014) and infections at extra-genital sites have gained increasing significance in this population (Marcus et al, 2011;Rieg et al, 2008;Barbee et al, 2017;Patton et al, 2014). Since untreated STIs at any site may serve as facilitators of HIV transmission, screening both for genital and extra-genital sites is recommended as standard of care among HIV positive individuals (Templeton et al, 2014;Pathela et al, 2013;Rotchford et al, 2000;Ghys et al, 1997;Politch et al, 2012).…”

Sexually Transmitted Infections Among Young Men Who Have Sex with Men: Experiences with Diagnosis, Treatment, and Reinfection

“…The prevention of HIV among YMSM remains a major public health concern. Given that MSM are also disproportionately affected by other STIs (Brewer et al, 2011; CDC, 2008; Kirkcaldy et al, 2013; Su et al, 2011), and that rectal STIs are associated with increased HIV transmission (Barbee et al, 2017; Bernstein et al, 2010; Kelley et al, 2015), there is a clear need for continued HIV/STI prevention in this population. The fact that most YMSM in our study sought treatment for their STIs is encouraging and suggests that testing can lead to treatment for YMSM.…”

“…Further, in a sample of YMSM, only 57.6% had ever been tested for chlamydia, gonorrhea, or syphilis (Meanley, Gale, Harmell, Jadwin-Cakmak, Pingel, & Bauermeister, 2015). Given that YMSM have the highest rate of new HIV infections (CDC, 2016a) and that rectal STIs are associated with increased HIV transmission (Barbee, Khosropour, Dombrowksi, & Golden, 2017; Bernstein, Marcus, Nieri, Philip, & Klausner, 2010; Kelley et al, 2015), there is a need to understand factors that contribute to STI transmission among YMSM. Several risk factors for STIs among MSM have been identified (e.g., younger age, non-White race/ethnicity, inconsistent condom use, receptive condomless anal sex [CAS], more sex partners) (Chow, 2015; Grov et al, 2016; Kelley et al, 2015; Mustanski, Feinstein, et al, 2017), but little is known about the experiences of YMSM with STI diagnosis and treatment.…”

Title: Keep It Up! 3.0: Study Protocol for a Type III Hybrid Implementation-Effectiveness Cluster-Randomized Trial

“…Sexually Transmitted Infection (STI) prevalence is also high among YMSM, (7)(8)(9) and STIs play an important role in increasing HIV transmission. (10)(11)(12) In fact, the Centers for Disease Control and Prevention (CDC) estimates a rectal STI causes a threefold increase in the per-act risk of HIV transmission during receptive anal sex. (13) Bridging the Research-Practice Divide Despite increased HIV risk, few interventions in the CDC Compendium of Evidence-Based Interventions (EBIs) and Best Practices for HIV Prevention Programs (6) are focused on YMSM.…”