Should screening for Chlamydia trachomatis and Neisseria gonorrhoeae in HIV‐men who have sex with men be recommended?

Abstract

IntroductionSexually transmitted infections (STI) like Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been associated with increased risk of HIV acquisition [1]. It has been also described as a high prevalence of asymptomatic CT and NG infections in men who have sex with men (MSM) [2]. The aim of this study was to know the prevalence of CT and/or NG infections in asymptomatic HIV-MSM and the related factors.Materials and MethodsProspective study of a cohort of asymptomatic HIV-MSM with follow-up in Malaga (southern Spain) during October 2012–May 2014. Patients with an opportunistic event or who received active antibiotic therapy for CT and/or NG in the previous month were excluded. All of them completed a questionnaire about sexual behaviour, barrier methods and recreational drugs use. Demographical, epidemiological, clinical, analytical and therapeutic data were also collected. Pharyngeal and rectal swabs, and urine samples were collected to be tested for CT and NG by nucleic acid amplification test (c4800 CT/NG. Roche Diagnostics, Mannheim, Germany) [3]. Statistics analysis: SPSS 17.0.Results255 patients were asked to participate and 248 of them accepted. Median age was 37.7 (30.6–46.3) years, median time since HIV diagnosis was 47.7 (10.5–104.1) months, and median CD4 cells count was 607 (440–824) cell/µL. There were 195 (78.6%) patients on antiretroviral therapy; 81.5% of them had undetectable viral load. 80.5% of the patients had a past history of STI. Infection by CT and/or NG was diagnosed in 24 (9.7%) patients. Overall four urine samples, two pharyngeal, and 15 rectal ones were positive for CT, and five pharyngeal and five rectal swabs were positive for NG. Two patients were co-infected by CT and NG: one with CT in urine and both in rectum, another with CT in urine and rectum and NG in pharynx. One patient presented CT in pharynx and rectum, and two patients NG in pharynx and rectum. Positive CT and/or NG tests were only related with detectable HIV viral load (OR 3.08, 95% CI 1.2–7.4; p=0.01). It was not related with sexual behaviour, nor with alcohol or recreational drugs use.ConclusionsSTI screening had a great acceptance in this population. There was a high prevalence of asymptomatic CT and/or NG infections. Rectum sample was the most effective one. Viral suppression could protect from these STI. Screening should be recommended in HIV-MSM.

Acceptability of rectal self-sampling in non-clinical venues for chlamydia and gonorrhea testing among men who have sex with men: A cross-sectional study in Shenzhen, China

“…Our study also suggested that more than half of respondents believed that routine CT screening was the most appropriate to undertake CT test and most of them were willing to undertake routine CT screening. A previous study found that CT screening had great acceptance in this population ( 26 ). However, a third of participants were willing to undertake routine CT screening if the test is free, which suggested that offering free CT tests could expand the uptake of screening.…”

Sexual behaviour patterns and STI risk: results of a cluster analysis among men who have sex with men in Portugal

“…The findings are also in line with previous studies that demonstrated the association between HIV infection and higher incidence and prevalence rates of other STIs, supporting linked epidemics of STIs and HIV in Portuguese MSM. [26][27][28] Interventions for MSM should combine HIV-testing and STI-testing, and for some of the clusters identified in our analysis, should be comprehensive, including rectal and pharyngeal swabbing to screen for asymptomatic gonorrhoea and chlamydia, especially considering the current challenges with antimicrobial resistance. 29 It should be mentioned that, the information on the natural history of these asymptomatic infections is scarce, and the public health benefit and the risks associated with the wide roll-out of this screening strategy remain unclear.…”