Incidence Of Bacterial Sexually Transmitted Infections Research Articles

Incidence and risk factors for recurrent sexually transmitted infections among MSM on HIV pre-exposure prophylaxis.

High rates of sexually transmitted infections (STIs) have been reported among pre-exposure prophylaxis (PrEP) users. We wished to assess the incidence and risk factors for recurrent STIs. The ANRS IPERGAY trial was a prospective study investigating PrEP among MSM and transgender women in outpatient clinics in France and Canada. In all, 429 participants were enrolled, offered up to 4 years of PrEP and screened for bacterial STIs (syphilis, chlamydia and gonorrhea) at baseline and every 6 months. STIs incidence was calculated yearly. Cox proportional hazards model regression was used to explore associations between participants characteristics at baseline and recurrent STI during follow-up. Over a median follow-up of 23 months, bacterial STI incidence was 75, 33, 13, 32 and 30 per 100 person-years for all STIs, rectal STIs, syphilis, gonorrhea and chlamydia, respectively. STI incidence significantly increased from the first year to the fourth year of the study (55 vs. 90 per 100 person-years, P < 0.001). During the study period, 167 participants (39%) presented with more than one bacterial STIs which accounted for 86% of all STIs. Baseline risk factors associated with recurrent STIs in a multivariate analysis were an STI at baseline [hazards ratio: 1.48 (95% confidence interval (CI): 1.06-2.07), P = 0.02], more than eight sexual partners in prior 2 months [hazards ratio: 1.72 (95% CI: 1.21-2.43), P = 0.002] and the use of gamma-hydroxybutyrate [hazards ratio: 1.66 (95% CI: 1.16-2.38), P = 0.005]. STI incidence was high and increased over time. Most STIs were concentrated in a high-risk group that should be targeted for future interventions.

Daily and event-driven pre-exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence.

IntroductionPre‐Exposure Prophylaxis (PrEP) is highly effective in reducing the risk for HIV infection among men who have sex with men (MSM) and may have an important impact in slowing down the HIV epidemic. Concerns remain however about low adherence, increased risk behaviour and reduced condom use when using PrEP. The aim of this study was to assess these factors prospectively among MSM using daily and event‐driven PrEP in Belgium.MethodsAn open‐label prospective cohort study was conducted from October 2017 to May 2018 at the Institute of Tropical Medicine, in Antwerp, Belgium. At enrolment, MSM at high risk for HIV chose between daily or event‐driven PrEP. They were allowed to switch regimens or stop taking PrEP at each of their tri‐monthly visits. Data were collected on an electronic case report form, web‐based diary and self‐administered questionnaire. Screening for HIV and other Sexually Transmitted Infections (STIs) was also performed.ResultsTwo hundred MSM were followed up for a total duration of 318 person‐years. At month 18, 75.4% of the participants were on daily and 24.6% were on event‐driven PrEP. The mean proportion of covered sex acts by PrEP for the complete follow‐up period was 91.5% for all participants, 96.5% for daily and 67.0% for event‐driven PrEP use. The number of casual and anonymous sex partners was significantly higher for daily users, as compared with event‐driven users, but did not change over time. In contrast, the mean proportion of condomless receptive anal intercourse with casual and anonymous partners increased significantly during follow‐up, for both daily and event‐driven use (p < 0.0001 for all 4 trends). No new HIV infection was diagnosed during follow‐up. The incidence of bacterial STIs was 75.4 per 100 person‐years (95% CI 63.8 to 89.1). We did not detect a significant change in N. gonorrhoeae/C. trachomatis incidence over time. The incidence of hepatitis C was 2.9 per 100 person‐years.ConclusionsPrEP is an effective and well adopted HIV prevention tool for MSM in Belgium. Participants adapted daily and event‐driven regimens to their own needs and were able to adapt their PrEP adherence to risk exposure.

Sexual behaviours and sexually transmitted infection outcomes in a cohort of HIV-negative men who have sex with men attending sexual health clinics in England.

Men who have sex with men (MSM) attending sexual health (SH) clinics are at high risk for HIV acquisition and are disproportionately affected by sexually transmitted infections (STIs). We collected standardised behavioural data from MSM attending clinics to characterise sexual behaviours and identify predictors for HIV and STIs. In 2012–2013, HIV-negative MSM attending five SH clinics in England reported sexual behaviours in the previous three months via a self-administered questionnaire. Behaviours were linked to the individual’s clinical records using national surveillance. The prevalence and incidence of bacterial STIs (gonorrhoea, Chlamydia, lymphogranuloma venereum and syphilis) and incidence of HIV were calculated. Adjusted odds ratios and hazard ratios with 95% confidence interval (CI) were reported for significant predictors. Of 1278 HIV-negative MSM, 54% were of white ethnicity and UK-born and 43% were 25–34 years old. Almost all men reported at least one partner in the last three months. Half reported condomless anal sex and 36% condomless receptive anal intercourse (CRAI). Incidence of bacterial STIs was 46/100 (95%CI 39–54) person years (py) and of HIV was 3.1/100 (95%CI 1.7–5.6) py. A STI at baseline and CRAI with increasing numbers of partners were associated with both incident infections. In this cohort of MSM high-risk behaviours and STIs were prevalent. Engagement in CRAI increased the likelihood of subsequent infection, while men diagnosed with a bacterial STI were at increased risk of a future STI. Clinical and behavioural risk assessments to determine an individual’s risk of infection could allow a more nuanced prevention approach that has greater success in reducing transmission.

High Rate of Asymptomatic Bacterial Sexually Transmitted Infections (STIs) in Men who Have Sex with Men on Pre Exposure Prophylaxis (PrEP)

BackgroundHigh rates of bacterial STIs have been reported in high-risk MSM receiving tenofovir/emtricitaine (TDF/FTC) pre-exposure prophylaxis against HIV (PrEP) in clinical trials. However, systematic screening for STIs may amplify the diagnosis of asymptomatic infections in this population. We report the results of STI incidence in MSM enrolled in a PrEP program in Lyon University Hospital, France.MethodsAll patients addressed for PrEP in the department were enrolled. Baseline assessment included HIV serology, serum creatinine and STI screening (syphilis, HAV, HBV and HCV serology and N. gonorrheae/C. trachomatis PCR assay on urine, anal and pharyngeal swabs). HIV test, creatinine, bacterial STIs and HCV screening were repeated every 3 months. Incidence rates were determined per 100 patient-year (/100PY).ResultsFrom January to September 2016, 211 patients were enrolled. All patients were MSM reporting unprotected anal sex (median age 36.4 years). Median condom use was 50%. 6% were escorts or prostitutes, 46% participate in sex parties, 53% used chemsex. Nine patients did not start PrEP, including 3 patients with HIV primary infection at baseline. 32 patients were lost to follow-up (FU). Median FU was 6.3 months for the remaining 170 patients (97 PY). No patient acquired HIV and 3 patients had acute HCV during FU.ConclusionA high prevalence and incidence of bacterial STIs were observed in high-risk MSM engaged in a PrEP program. All prevalent STIs and 80.3% of incident STIs were asymptomatic. Frequent screening and treatment of asymptomatic STI are warranted to reduce the spread of STIs in this population.STI history (%)Baseline prevalence(% symptomatic)Incidence rate /100PY(% symptomatic) Syphilis 37.93.8 (0)14.8 (18.7) N. gonorrheae 48.27.6 (0)58.7 (22.5)Pharyngeal3.9 (0)22.5 (0)Urine1.0 (0)12.0 (41.2)Anal3.9 (0)34.4 (25.0) C. trachomatis 40.57.6 (0)47.6 (16.0)Pharyngeal1.0 (0)9.6 (0)Urine1.0 (0)8.4 (30.0)Anal5.8 (0)33.5 (15.6) All bacterial STIs 74.216.3 (0)86.9 (19.7)Disclosures L. Cotte, GILEAD: Scientific Advisor, Consulting fee

P29 Audit of re-testing and reinfection in london men who have sex with men with acute stis in a large gum outpatient clinic

Background Men who have sex with men (MSM) in the UK are at relatively high risk of acquiring new STIs. The British Association of Sexual Health and HIV recommend active recall of MSM diagnosed with sexually transmitted infections (STIs) for retesting after 3 months. Objectives An audit was undertaken to assess the incidence of bacterial STIs, and rates of re-screening and re-infection amongst MSM attending a large genitourinary (GU) outpatient clinic in London. Methods A retrospective audit of GU coding data on MSM attendees aged >18 years between January and December 2014 was performed. Data was collected on patient demographics, STI tests performed and diagnoses. Results 397 MSM were diagnosed with 826 new bacterial STIs during the audit period (762 STIs over 534 episodes occurred in the initial 9 month period). 145 (37%) patients were HIV infected. In 98/534 (18%) episodes, a repeat screen was performed within 3 months (excluding screening within the initial 6 weeks after an STI was diagnosed); in 21 (21%) of these episodes, a further 1 ≥ STI was diagnosed. Overall, the mean time to re-screening during the study period was 108 days (excluding initial 6 weeks; range 43–282). In 149/534 (28%) of STI episodes, no repeat STI screen was performed within the period analysed. Conclusion The incidence of STIs and re-infection in this high risk group is high, however prompt re-screening rates are low, highlighting the need for active recall. Routine 3 month text recall of MSM with an STI has since been implemented.

P3.007* Gonorrhoea, Syphilis, Chlamydia and Trichomonas in Children Under Thirteen Years of Age: National Surveillance in the UK and Republic of Ireland

BackgroundChildren who have been sexually abused (CSA) are potentially at risk of sexually transmitted infections (STI). It is not known how frequently such infections are identified within the population nor...

Incidence of sexually transmitted infections in HIV-infected and HIV-uninfected adolescents in the USA

Little is known about the incidence of bacterial sexually transmitted infections (STIs) among HIV-infected versus HIV-uninfected adolescents. This secondary analysis of a national, multisite study included adolescents aged 12-18 years who were behaviourally HIV-infected (n = 346) or HIV-uninfected but at-risk (n = 182). Incidence rates of bacterial STIs (gonorrhoea, chlamydia [CT] and trichomonas [TV; women]) were calculated using Poisson modelling. Factors associated with incident STIs were explored using Cox proportional hazards modelling. HIV-infected versus HIV-uninfected women had higher TV incidence (1.3 versus 0.6/100 person-months; P = 0.002). HIV-uninfected versus HIV-infected women had higher CT incidence (1.6 versus 1.1/100 person-months; P = 0.04). Among women, demographic, behavioural and HIV-related factors were associated with incident STIs. Among men, there were no differences in incident STIs. In this first analysis comparing STI incidence between HIV-infected and HIV-uninfected adolescents, bacterial STI incidence among women significantly differed by HIV status, and factors associated with incident STIs varied by STI and HIV status.

Assessing the impact of national anti-HIV sexual health campaigns: trends in the transmission of HIV and other sexually transmitted infections in England

Objective: To assess the impact of the sexual component of AIDS and HIV campaigns on transmission of HIV and other sexually transmitted infections (STIs). Design: Comparison of time series data....

Comparison of risk factors for four sexually transmitted infections: results from a study of attenders at three genitourinary medicine clinics in England

Objective: To compare the risk factors for four common sexually transmitted infections (STIs) in attenders at three large urban genitourinary medicine (GUM) clinics in England. Methods: Clinical, demographic, and behavioural...