Abstract
HIV seroadaptive behaviours may have contributed to greater sexually transmitted infection (STI) transmission in HIV-positive men who have sex with men(MSM) and to the global increase in STIs. Using multiple national surveillance data sources and population survey data, we estimated the risk of STIs in HIV-positive MSM and assessed whether transmission in HIV-positive MSM has contributed to recent STI epidemics in England. Since 2009, an increasing proportion of STIs has been diagnosed in HIV-positive MSM, and currently, the population rate of acute bacterial STIs is up to four times that of HIV-negative or undiagnosed MSM. Almost one in five of all diagnosed HIV-positive MSM in England had an acute STI diagnosed in 2013. From 2009 to 2013, the odds of being diagnosed with syphilis increased from 2.71 (95% confidence interval (CI) 2.41–3.05, p<0.001) to 4.05 (95%CI 3.70-4.45, p<0.001) in HIV-positive relative to HIV negative/undiagnosed MSM. Similar trends were seen for gonorrhoea and chlamydia. Bacterial STI re-infection rates were considerably higher in HIV-positive MSM over a five-year follow-up period, indicative of rapid transmission in more dense sexual networks.These findings strongly suggest that the sexual health of HIV-positive MSM in England is worsening, which merits augmented public health interventions and continued monitoring.
Highlights
The United Kingdom (UK) has seen a steady increase in diagnoses of sexually transmitted infections (STIs) in the last decade, in particular, in men who have sex with men (MSM)
From 2009 to 2013, this proportion increased for all acute STIs: from 25% to 40% for syphilis, 16% to 25% for chlamydia, 15% to 24% for gonorrhoea, 19% to 21% for genital herpes and 7% to 10% for genital warts
For HIV-negative/undiagnosed MSM, the rate of acute bacterial STIs increased to a lesser degree (19 per 1,000 to 38 per 1,000)
Summary
The United Kingdom (UK) has seen a steady increase in diagnoses of sexually transmitted infections (STIs) in the last decade, in particular, in men who have sex with men (MSM). Outbreaks of less common STIs such as Lymphogranuloma venereum (LGV) [5], together with shigellosis (which can be sexually transmissible) [6] in this population are of particular concern. There is increasing evidence that HIV-positive MSM in the UK are disproportionately affected by STIs. Recent data demonstrated that of MSM diagnosed with syphilis, 35% were HIV positive [7]. HIV-positive MSM have been found to account for more than 80% of LGV cases [5] In part, these observations may reflect seroadaptive behaviours in HIV-positive MSM [8], in which different sexual practices such as unprotected (i.e. condomless) anal intercourse are adopted according to the reported HIV status of both partners in order to reduce the risk of transmitting or acquiring HIV. Seroadaptive behaviours may come at a cost of increased transmission of STIs [10,11,12]
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