Median Number Of Sexual Partners Research Articles

Sexual behaviour and incidence of sexually transmitted infections among men who have sex with men (MSM) using daily and event-driven pre-exposure prophylaxis (PrEP): Four-year follow-up of the Amsterdam PrEP (AMPrEP) demonstration project cohort.

An increasing number of countries are currently implementing or scaling-up HIV pre-exposure prophylaxis (PrEP) care. With the introduction of PrEP, there was apprehension that condom use would decline and sexually transmitted infections (STIs) would increase. To inform sexual health counselling and STI screening programmes, we aimed to study sexual behaviour and STI incidence among men who have sex with men (MSM) and transgender women who use long-term daily or event-driven PrEP. The Amsterdam PrEP demonstration project (AMPrEP) was a prospective, closed cohort study, providing oral daily PrEP and event-driven PrEP to MSM and transgender women from 2015 to 2020. Participants could choose their PrEP regimen and could switch at each three-monthly visit. STI testing occurred at and, upon request, in-between 3-monthly study visits. We assessed changes in numbers of sex partners and condomless anal sex (CAS) acts with casual partners over time using negative binomial regression, adjusted for age. We assessed HIV incidence and changes in incidence rates (IRs) of any STI (i.e., chlamydia, gonorrhoea, or infectious syphilis) and individual STIs over time using Poisson regression, adjusted for age and testing frequency. A total of 367 participants (365 MSM) commenced PrEP and were followed for a median 3.9 years (interquartile range [IQR] = 3.4-4.0). Median age was 40 years (IQR = 32-48), 315 participants (85.8%) self-declared ethnicity as white and 280 (76.3%) had a university or university of applied sciences degree. Overall median number of sex partners (past 3 months) was 13 (IQR = 6-26) and decreased per additional year on PrEP (adjusted rate ratio [aRR] = 0.86/year, 95% confidence interval [CI] = 0.83-0.88). Overall median number of CAS acts with casual partners (past 3 months) was 10 (IQR = 3-20.5) and also decreased (aRR = 0.92/year, 95% CI = 0.88-0.97). We diagnosed any STI in 1,092 consultations during 1,258 person years, resulting in an IR of 87/100 person years (95% CI = 82-92). IRs of any STI did not increase over time for daily PrEP or event-driven PrEP users. Two daily PrEP users, and no event-driven PrEP users, were diagnosed with HIV during their first year on PrEP. Study limitations include censoring follow-up due to COVID-19 measures and an underrepresentation of younger, non-white, practically educated, and transgender individuals. In this prospective cohort with a comparatively long follow-up period of 4 years, we observed very low HIV incidence and decreases in the numbers of casual sex partners and CAS acts over time. Although the STI incidence was high, it did not increase over time. The study was registered at the Netherlands Trial Register (NL5413) https://www.onderzoekmetmensen.nl/en/trial/22706.

2211. High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae identified through routine screening for rectal, pharyngeal, and urethral infections within a HIV pre-exposure prophylaxis program in Hanoi, Vietnam

Abstract Background Pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention and is being scaled up globally. Patients on PrEP have high rates of bacterial STIs, like Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), thus routine screening is recommended. However, access to screening tests for STIs are limited in many low-resource settings. The objectives of this study were to determine the prevalence of CT and NG among participants in Vietnam’s first PrEP program. Methods From January through April 2022 participants in the PrEP program at the Sexual Health Promotion Clinic in Hanoi, Vietnam were recruited to study STI prevalence. Study participants completed a survey collecting demographic, behavioral and clinical characteristics. Participants self-collected urine, rectal, and pharyngeal specimens for nucleic-acid testing. Participants positive for NG had an additional specimen collected for culture and antibiotic susceptibility. Results In total, 108 participants were enrolled, median age was 24 years (IQR: 22– 28). All were male and reported having sex with men in the prior 12 months. The median number of sex partners in the prior 1 month was 1 (IQR: 1 – 2). Symptoms within the prior week were reported by 41.7% (45/108) – 19.4% reported rectal, 15.7% reported urethral, and 26.9% reported pharyngeal symptoms. The overall prevalence of CT or NG infections was 31.5% (34/108). The prevalence of CT was 24.1% (26/108); by anatomic site, there were 17 (15.7%) rectal, 10 (9.3%) pharyngeal, and 6 (5.6%) urethral infections. The prevalence of NG was 13.0% (14/108); there were 12 (11.1%) pharyngeal, 9 (8.3%) rectal, and 0 urethral infections. Among participants reporting any symptoms, CT prevalence was 26.7% (12/45) and NG prevalence 13.3% (6/45). All infections were treated. Conclusion The prevalence of CT and NG was very high among this population of young MSM in a PrEP program in Hanoi, Vietnam. A high proportion of CT infections were rectal (65%) and 86% of NG infections were pharyngeal. These findings highlight the need for expanded access to extragenital nucleic-acid testing among PrEP programs in low- and middle-income countries. Studies demonstrating the benefit of CT/NG screening and treatment within PrEP programs are urgently needed. Disclosures Jeffrey Klausner, MD MPH, Cepheid: Advisor/Consultant|Cepheid: Grant/Research Support|Cepheid: Research equipment and supplies.

Sexual behavior and drug use impact in gay, bisexual, and other men who have sex with men

BackgroundThe emergence of chemsex has raised several concerns about gay, bisexual, and other men who have sex with men's (GBMSM) health. In this study we aim to analyze illicit drugs and chemsex use, sexual behavior and sexually transmitted infections (STI) in GBMSM who attended to a sexual health clinic and to explore any potential association between drug use and STI. MethodsWe conducted an observational study between January and June 2019 among GBMSM population attending to a STI clinic in Barcelona, Spain. An anonymous self-administered questionnaire was given consecutively to all participants older than 18 years who accepted to participate. ResultsA total of 514 GBMSM (median age of 34 years-old) were included. The median number of sexual partners in the last year was 20. Seventy-one percent did not use condoms consistently for receptive anal intercourse. Drug abuse prevalence in the preceding year was 64.2%, and 26.5% of the individuals practiced chemsex. Gamma-hydroxibutyrate/gammabutyrolactone, poppers and methamphetamine were the most common drugs in chemsex. Chemsex was associated to group sex (OR 9.8 [95 CI: 4–24]), HIV infection (OR 2.5 [95 CI: 1.1–5.8]), taking pre-exposure prophylaxis (OR 3.2 [95 CI: 1.5–7.1]), developing gonorrhea (OR 3.7 [95 CI: 1.5–8.8]) or syphilis (OR 6.7 [95 CI: 2.4–18.7]). ConclusionsThe prevalence of drug use and chemsex was high among GBMSM in Barcelona. Chemsex was associated with group sex, taking PrEP, and contracting syphilis, gonorrhea, and HIV.

Changes in Substance Use and Sexual Behaviors After a Sexually Transmitted Infection Diagnosis Among a Cohort of Men Who Have Sex With Men in Los Angeles, CA.

Despite declines in substance use and sexual behaviors after a sexually transmitted infection, reinfections were high suggesting that men who have sex with men with sexually transmitted infections occupy sexual networks with high transmission probabilities and prevention efforts should consider sexual network characteristics.BackgroundSexually transmitted infections (STIs), STI reinfection, human immunodeficiency virus (HIV) acquisition, and changes in behaviors after an STI were examined in a cohort of men who have sex with men (MSM) in Los Angeles, CA.MethodsData from a longitudinal study of MSM enrolled from 2014 with at least 1 follow-up visit through March 2020 were analyzed (n = 447; 1854 visits). Study visits every 6 months included self-interviews for sexual behaviors, substance use, and specimen collection for chlamydia, gonorrhea, syphilis, and HIV testing. Changes in behaviors were assessed using the McNemar test, and participants not diagnosed with an STI served as controls for a difference-in-difference (DiD) analysis of changes over time.ResultsCumulative incidence of an STI was 55% (248 of 447). At 24 months after STI diagnosis, methamphetamine use declined from 50% to 35% (P< 0.01), and median number of sex partners declined from 5 (interquartile range, 2–11) to 2 (interquartile range, 1–6;P< 0.01). Among participants at risk for HIV and diagnosed with an STI (n = 102), postexposure prophylaxis use was 35% and HIV seroconversion was 6%. Based on DiD analyses, participants diagnosed with an STI had higher levels of substance and a higher number of sex partners when compared with those with no STIs; however, declines in these behaviors were comparable to participants not diagnosed with an STI (PDID> 0.05).ConclusionsDespite behavior modifications after an STI diagnosis, STI/HIV incidence was high, suggesting that MSM with STIs occupy sexual networks where reductions in sexual and substance using behaviors do not protect them from ongoing exposure to STIs and HIV.

Sexual behaviours and clinical course of human monkeypox in Spain

Sexual behaviours and clinical course of human monkeypox in Spain

Sexual behavior and drug use impact in gay, bisexual, and other men who have sex with men

BackgroundThe emergence of chemsex has raised several concerns about gay, bisexual, and other men who have sex with men's (GBMSM) health. In this study we aim to analyze illicit drugs and chemsex use, sexual behavior and sexually transmitted infections (STI) in GBMSM who attended to a sexual health clinic and to explore any potential association between drug use and STI. MethodsWe conducted an observational study between January and June 2019 among GBMSM population attending to a STI clinic in Barcelona, Spain. An anonymous self-administered questionnaire was given consecutively to all participants older than 18 years who accepted to participate. ResultsA total of 514 GBMSM (median age of 34 years-old) were included. The median number of sexual partners in the last year was 20. Seventy-one percent did not use condoms consistently for receptive anal intercourse. Drug abuse prevalence in the preceding year was 64.2%, and 26.5% of the individuals practiced chemsex. Gamma-hydroxibutyrate/gammabutyrolactone, poppers and methamphetamine were the most common drugs in chemsex. Chemsex was associated to group sex (OR 9.8 [95 CI: 4–24]), HIV infection (OR 2.5 [95 CI: 1.1–5.8]), taking pre-exposure prophylaxis (OR 3.2 [95 CI: 1.5–7.1]), developing gonorrhea (OR 3.7 [95 CI: 1.5–8.8]) or syphilis (OR 6.7 [95 CI: 2.4–18.7]). ConclusionsThe prevalence of drug use and chemsex was high among GBMSM in Barcelona. Chemsex was associated with group sex, taking PrEP, and contracting syphilis, gonorrhea, and HIV.

Evidence of latent HPV infection in older Danish women with a previous history of cervical dysplasia.

Understanding whether human papillomavirus (HPV) may establish latency in the uterine cervix is important. A better understanding of HPV natural history is useful for clinical counseling of women attending screening and to accurately inform health prevention strategies such as screening and HPV vaccination. We evaluated the extent of latent HPV infections in older women with a history of abnormal cytology. We conducted a cross-sectional study in Aarhus, Denmark, from March 2013 through April 2015. Women were enrolled if they underwent cervical amputation or total hysterectomy because of benign disease. Prior to surgery, women completed a questionnaire and a cervical smear was collected for HPV testing and morphological assessment. For evaluation of latency (i.e., no evidence of active HPV infection, but HPV detected in the tissue), we selected women with a history of abnormal cervical cytology or histology, as these women were considered at increased risk of harboring a latent infection. Cervical tissue underwent extensive HPV testing using the SPF10-DEIA-LipA25 assay. Of 103 women enrolled, 26 were included in this analysis. Median age was 55 years (interquartile range [IQR] 52-65), and most women were postmenopausal and parous. The median number of sexual partners over the lifetime was six (IQR 3-10), and 85% reported no recent new sexual partner. Five women (19.2%) had evidence of active infection at the time of surgery, and 19 underwent latency evaluation. Of these, a latent infection was detected in 11 (57.9%), with HPV16 being the most prevalent type (50%). Nearly 80% (n = 14) of the 18 women with a history of previous low-grade or high-grade cytology with no treatment had an active or latent HPV infection, with latent infections predominating. HPV was detected in two of the six women with a history of high-grade cytology and subsequent excisional treatment, both as latent infections. HPV can be detected in cervical tissue specimens without any evidence of an active HPV infection, indicative of a latent, immunologically controlled infection. Modeling studies should consider including a latent state in their model when estimating the appropriate age to stop screening and when evaluating the impact of HPV vaccination.

Pilot study of pharyngeal Chlamydia trachomatis in HIV-positive and HIV-negative men who have sex with men.

Unlike pharyngeal Neisseria gonorrhoeae, less is known about pharyngeal Chlamydia trachomatis in men who have sex with men (MSM). We reviewed cases of pharyngeal chlamydia in MSM from January to December 2019. The overall prevalence of pharyngeal chlamydia was 75/6613 (1.13%; 95% confidence interval (CI) = 0.9-1.14). The median number of sexual partners was three, four (5%) reported throat symptoms and 20 (26%) were HIV positive. Multi-site and concomitant infection was common: rectal chlamydia [39 (52%)], urethral chlamydia [12 (16%)], early syphilis [2 (3%)] and gonorrhoea [14 (19%)]. HIV-positive MSM with pharyngeal chlamydia were older (P = 0.02) and more likely to have had previous syphilis (odds ratio = 4.9; 95% CI = 1.6-14.7; P = 0.005). Further research is needed to explore the characteristics of pharyngeal chlamydia and benefits of increased screening for asymptomatic pharyngeal chlamydia in MSM.

Pre-exposure prophylaxis use among men who have sex with men who have experienced problematic chemsex.

Men who have sex with men (MSM) who experience problematic chemsex are at high risk of acquiring HIV due to combined drug use and sexual behaviours. Pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV transmission in this group of men. The aim of this study was to examine the biopsychosocial characteristics associated with PrEP use among HIV-negative MSM who have experienced problematic chemsex. This was a cross-sectional analysis of secondary data collected during client assessments at a specialist alcohol and drug service based within the United Kingdom. We compared the socio-demographics, substance use, sexual behaviours and mental health of MSM who reported ever using PrEP to those who reported never using PrEP. Statistical analysis was conducted using the Mann–Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. Between August 2016 and July 2018, 165 HIV-negative MSM who engaged in chemsex had an assessment completed. Thirty-four per cent (n = 50/145) had ever used PrEP. The median age was 36 years (IQR: 30–42), 92% identified as gay (n = 152/165) and 79% were of white ethnicity (n = 130/164). The use of crystal methamphetamine was associated with higher levels of men ever using PrEP (40% versus 21%) (p= 0.047). Men who had ever used PrEP had a higher median number of sexual partners in the previous three months (20 versus 10) (p= 0.004) and had lower level of condom use in their sex lives (median reported 5% versus 50%) (p= 0.010) in comparison to men who had never used PrEP. It is encouraging that men having higher-risk sex had been accessing PrEP. However, further research is required to explore PrEP uptake, retention and adherence in this high-risk group.

Methamphetamine Use and Sexual Risk Behaviors among Men Who Have Sex With Men in a Mexico-US Border City.

Methamphetamine (meth) use and its related risk behaviors for HIV among men who have sex with men (MSM) are a public health concern across the Mexico-US border. This study aims to contribute to the limited literature of meth use and sexual risk behaviors among Latino MSM on the Mexico-US border. Data were drawn from the Meth Pilot Study (2014-2015) among men who use meth (n = 100). Descriptive statistics and bivariate analysis comparing MSM to non-MSM were conducted using Pearson's χ2 test, Fisher's exact tests, and Mann-Whitney U test; all tests were conducted using SPSS v.25. Most participants obtained meth in El Paso, Texas (87.2%), used meth orally (65.2%) or smoked (78.3%), and the most common reason for initiation was curiosity. Significant differences (P < .05) in meth use behaviors and sexual risk behaviors between MSM and non-MSM who used meth included: median number of sex partners (7 vs 3), being penetrated anally by last sexual partner (31.6% vs 1.4%), and engaging in transactional sex ever (63.2% vs 9.6%) and past 12 months (52.6% vs 6.8%). Finally, rates of HIV positivity were higher among MSM than non-MSM (10.5% vs 1.4%). Among men who use meth, MSM are engaging in higher HIV risk behaviors compared with non-MSM. Understanding these risks could help identify candidates for pre-exposure prophylaxis (PrEP) and evidence-based substance use disorder treatment options. This study reveals that Latino MSM who use meth is a high-risk group for HIV and a need for tailored interventions. (Am J Addict 2020;29:111-119).

Identification and characterization of latent classes based on drug use among men who have sex with men at risk of sexually transmitted infections in Amsterdam, the Netherlands.

Men who have sex with men (MSM) are at high risk for both drug use and sexually transmitted infections (STI). We aimed to (1) identify subgroups of drug use during sex among MSM in Amsterdam and after classifying participants and (2) compare sexual behaviour and STI across groups. Cross-sectional study. Latent class analysis was used to identify subgroups with similar drug use patterns, between which sexual behaviour and STI prevalence were compared. Four different studies conducted at the STI out-patient clinic in Amsterdam, the Netherlands, between January 2014 and June 2016. A total of 1130 self-declared MSM, aged ≥18years. Self-reported drug use, laboratory-confirmed STI, socio-demographics, sexual behaviour (including number of partners), condom use. Median age was 40years [interquartile range (IQR)=32-47]. We identified five latent classes of users, which we labelled: 'no substance' (n=162), 'alcohol' (n=159), 'nitrites and erectile dysfunction drugs (EDD)' (n=286), 'polydrug' (n=257) and 'chems' (n=266). Median number of sex partners significantly differed across classes (P<0.001), ranging from two (IQR=1-6) in the 'no substance' class to 20 (IQR=10-45) in the 'chems' class. The proportion of MSM reporting condomless anal sex also differed across classes (P<0.001), ranging from 45.6% in the 'no substance' class to 86.5% in the 'chems' class. Compared with the 'no substance' class, the odds of STI were 3.9-fold [95% confidence interval (CI)=1.1-14.4] higher in the 'alcohol' class, 8.9-fold (95% CI=2.7-29.2) higher in the 'nitrites and EDD' class, 12.8-fold (95% CI=3.9-41.9) higher in the 'polydrug' class and 15.0-fold (95% CI=4.6-48.8) higher in the 'chems' class. There are five distinct classes of drug use in a sexual context among men who have sex with men in Amsterdam, the Netherlands. Classes with higher levels of drug use appear to coincide with higher levels of sexual risk behaviour and sexually transmitted infections.

Implementation and impact of a technology-based HIV risk-reduction intervention among Thai men who have sex with men using “Vialogues”: a randomized controlled trial

ABSTRACTWe conducted a randomized control trial to evaluate the impact of a novel technology-based intervention on HIV risks and condom use behaviors among Thai men who have sex with men (MSM). Between April 2016 and August 2017, participants aged 18 years and above, and having engaged in unprotected sex in past six months were randomly assigned to control and intervention arm, and received HIV testing at baseline, month 6 and 12. Intervention arm participants engaged in 12-monthly HIV/STI prevention educational sessions delivered via Vialogues.com. Of 76 MSM enrolled, 37 were randomized to intervention and 39 to control arm. Median age was 28 (IQR 24–32) years. Thirty-three (89.2%) intervention arm participants completed all 12-monthly Vialogues sessions. At month 12, intervention arm had higher retention rate (p = 0.029) and higher median percentage of condom use for anal intercourse (p = 0.023) versus control arm. Over the 12-month period, intervention arm reported significant reduction in self-perceived HIV risk (p = 0.001), popper usage (p = 0.002), median number of sexual partners (p = 0.003), and increased median condom use percentage (p = 0.006). Our study highlights that “Vialogues” intervention significantly reduced number of sexual partners and condomless anal intercourse rates among Thai MSM, and has positive implications for reducing epidemic among key populations.

Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV

IntroductionErectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM) has been variably associated with increased risk behaviors and acquisition of sexually transmitted infections (STIs). AimWe measured the association of EDM prescription with bacterial STI testing, STI infection and sexual behavior among men engaged in HIV care. MethodsA retrospective cohort study was conducted among HIV-infected men in care at an urban HIV clinic in Birmingham, Alabama between 2008 and 2016. Paired data analysis was used to compare STI testing and behavioral outcomes during the 12-month period before and after EDM prescription. Main Outcome MeasuresOur study outcomes were STI testing and infection rates for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and incident syphilis as well as risk behaviors before and after EDM prescription. ResultsOf 2924 HIV-infected men engaged in care, 589 (20%) initiated EDM with a new prescription from a clinic provider during the study period. During the year after EDM prescription, all STI testing rates decreased: CT (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), GC (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), and syphilis (OR = 0.28; 95% CI: 0.20 - 0.38; P < .001). A total of 43 STIs were detected in this study (10 CT, 8 GC, and 25 syphilis) and 42/43 occurred among men who have sex with men (MSM). Sexual activity rates were high before and after EDM (87.6% vs 82.9%; P = .08), and consistent condom use was rare (6.6% in both time periods). After EDM prescription, the median number of sexual partners in the past 6 months decreased from 2 to 1 among MSM and was stable at 1 among men who have sex with women. Clinical ImplicationManagement of ED in HIV clinic provides an excellent opportunity to discuss risk reduction, safer sex practices, and the importance of routine STI screening to prevent HIV/STI transmission. Strength & LimitationsThis study provides insight into a common but understudied clinical scenario-ED in men with HIV-in an urban clinic population that is representative of the Southeastern United States. Adherence for ED medication was not assessed and STI risk behaviors were self-reported. ConclusionEDM prescription did not lead to any detectable change in risk behavior in this setting but bacterial STI was common among MSM who were tested.Heudebert JP, Tamhane A, Burkholder GA, Dionne-Odom J. Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV. J Sex Med 2019;16:691–700.

Characteristics of Gay, Bisexual and Other Men Who Have Sex With Men With Multiple Diagnoses of Infectious Syphilis in British Columbia, Canada, 2005-2014.

Infectious syphilis has increased substantially over the past decade. Targeting limited public health resources toward subpopulations with multiple reinfections may have a large impact in reducing onward transmission within a community. A chart review was conducted for individuals with 4 or more infectious syphilis diagnoses between 2005 and 2014 (the top 1% of all syphilis diagnoses in British Columbia, Canada). We characterized the sociodemographics, partner notification outcomes and social network. Between 2005 and 2014, there were 30 individuals with 4 or more syphilis diagnoses, accounting for 139 diagnoses. All were men who have sex with men and 29 (96%) were human immunodeficiency virus-positive. Of the 139 diagnoses, 65% occurred in the early latent stage of infection, 22% in the secondary stage, and 14% in the primary stage. The median number of sexual partners per diagnosis was 5 (range, 1-50). Among the 838 partners reported, 79% were notifiable, 53% were notified, and 23% were reported to be tested or treated. Sexual network mapping showed that almost half of the members of this group could be linked to one another either directly or indirectly via partners over 10 years. Social network mapping demonstrated high connectivity, with 4 venues associated with almost two thirds of the study population. The connectivity and recurrent diagnoses in this study population suggest potential benefits of targeted interventions to individuals with multiple diagnoses and their partners. Our study highlights the need for enhanced care, increased syphilis testing frequency, and exploring alternative preventative methods among individuals with syphilis rediagnoses to reduce syphilis incidence.

Polygamy, sexual behavior in a population under risk for prostate cancer diagnostic: an observational study from the Black Sea Region in Turkey.

ABSTRACTAim:Although prostate cancer (PCa) is the most common cancer type in men, a replaceable risk factor has not yet been established. In our study, we assessed the relationship between the number of sexual partners, age of first sexual experience and age of first masturbation and prostate cancer incidence.Materials and Methods:In Ordu University Department of Urology between January 2013 and September 2016, in PSA elevation and rectal examination, patients with prostate biopsy were evaluated due to nodule palpation in the prostate. At younger ages and at present, their first masturbation ages, first sexual debut ages, and total sexual partner numbers were recorded. The correlation between the obtained data and PCa frequency was evaluated.Results:The study included 146 patients with PCa identified on biopsy and 171 patients with benign biopsy results who answered the questions. 66.7% of the ones whose biopsy results were benign and 40.6% of cancer suspects had only one sexual partner. The median number of sexual partners was 1±4 (1-100) in the benign group and 2±6 (1-500) in the malignant group (p=0.039). There was a negative correlation between age of first sexual debut and number of partners (r: −0,479; p <0.001).Conclusion:In our study, it appears that there may be an association between the number of sexual partners and prostate cancer in the patient group with PSA level above 4ng/mL. Avoidance of sexual promiscuity or participation in protected sex may be beneficial to protect against prostate cancer.

P105 Characteristics of frequent attenders at a central london sexual health service

IntroductionBASHH guidance recommends screening for STIs up to every 3 months for individuals at risk of HIV. Conversely, commissioning pressures aim to reduce inappropriate attendances. We describe below the characteristics and outcomes of frequent attenders at our service.MethodsNotes review of individuals with 4 or more new or re-book attendance episodes at a central London sexual health service between 1stApril 2015 and 31stMarch 2016.Results170 individuals received more than 4 new episodes of clinical care in a year; 145(85%) were male, 136 MSM. 21(12%) were female, 4(2.4%) transgender. 23(14%) of the patients were HIV positive, all MSM. Median age was 31 years. Median number of sexual partners in preceding 3 months was 6. 75(44%) disclosed chemsex activity in the preceding month.In the 12 months from April 2015, there were 442 new STIs in this population, an average of 2.6 per patient: 346 STI diagnoses were in the 147 HIV-negative individuals and 96 in the 23 HIV-positive individuals. In HIV-negatives, the diagnosis was a rectal bacterial STI in 36% and syphilis in 7%. 206 courses of PEP were prescribed; 25 individuals received 4 or more PEP courses. There were 5 new diagnoses of blood borne virus infections; 2 hepatitis C, both in HIV positive MSM, and 3 HIV.DiscussionThe majority of frequent attenders at our clinic had indicators of high risk sexual behaviour. The high number of STIs and PEP prescriptions implies that the frequent attendances are appropriate in this patient population.

Is rectal douching and sharing douching equipment associated with anorectal chlamydia and gonorrhoea? A cross-sectional study among men who have sex with men

IntroductionMen who have sex with men (MSM) are at high risk for anorectal chlamydia and gonorrhoea infections. Many MSM use rectal douches in preparation for sex, which might break down...

P172 High HIV incidence in MSM diagnosed with early syphilis: a role for PrEP?

Background Understanding the risk factors for HIV acquisition allows targeted interventions to reduce HIV transmission such as PrEP. Aims/Objectives To evaluate HIV incidence in HIV-negative MSM with early syphilis infection. Methods A retrospective case-note review of MSM who were diagnosed with early syphilis between January and June 2014 at a London sexual health clinic. Results 206 MSM were diagnosed with early syphilis: 110 HIV-negative; 96 HIV-positive. For 110 HIV-negative MSM, median age was 32 y, median number of sexual partners in last 3 months was 4. Reported drug use in the previous month was 38%; 19% had injected drugs. Syphilis stage was primary (31%), secondary (25%), early latent (45%).Up to February 2016, total follow-up was 144 person-years. 12 (11%) were newly diagnosed HIV-positive. HIV incidence was 8.3 (95% confidence interval, CI 4.2–14) per 100 person-years follow-up (HPYFU). Incidence of rectal STIs was: rectal chlamydia, 27 HPYFU (CI 19–36); rectal gonorrhoea, 33 HPYFU (CI 25–44); syphilis re-infection, 10 HPYFU (CI 5.7–17). Conclusions The significant risk of HIV seroconversion following a diagnosis of early syphilis suggests that this group may particularly benefit from the use of pre-exposure prophylaxis. The high levels of subsequent rectal infections support the inclusion of regular STI screening in PrEP management guidelines.

P094 Chlamydia trachomatis(CT) positivity rate at 2 weekNeisseria gonorrhoeae(NG) test of cure (TOC)

Background/introduction Whilst guidelines recommend NG TOC 2 weeks after treatment, there is little data on the optimum time to perform a TOC for CT in those for whom this is indicated. Current BASHH guidelines recommend deferring TOC for at least 3 weeks after treatment because residual chlamydial DNA may persist. Aim(s)/objectives Patients who are treated for NG and CT co-infection re-attending for subsequent NG TOC are tested for both infections by NAAT providing the opportunity to evaluate the CT positivity rate at re-attendance. Methods A retrospective case review of co-infected GC/CT positive (analysed with Cepheid GeneXpert) patients tested in a’London sexual health clinic over 12 consecutive months was’performed. TOC details were evaluated, and appropriate antibiotic treatment according to BASHH guidelines was assessed. Results 480 patients tested positive for both infections and 132 attended for TOC within 21 days of treatment (median 15 days, IQR 14–17). Of these 131 were male, of whom 126 MSM; median age was 35 y and median number of sexual partners in previous 3 months was 5. Site of CT infection was rectal (94), urethral (49), throat (11), vulvovaginal (1). At TOC, 6 (4.5%) had a persistent positive CT NAAT: rectum (3), urethra (3). One patient with persistent rectal CT had received treatment with azithromycin; the other 5 received BASHH preferred treatment. By comparison, 3 (2.3%) had a positive NG NAAT at TOC. Discussion CT positivity 15 days after treatment is low, suggesting that TOC at 2 weeks may be a possible management strategy.

Uptake of PrEP and condom and sexual risk behavior among MSM during the ANRS IPERGAY trial

ABSTRACTThe double-blind phase of the randomized ANRS IPERGAY trial, evaluating sexual activity-based oral HIV pre-exposure prophylaxis (PrEP), was conducted among high-risk men who have sex with men (MSM). Results showed an 86% (95% CI: 40–98) relative reduction in HIV incidence among participants with tenofovir disoproxil fumarate–emtricitabine vs. placebo. The present pooled analysis aimed to analyze (i) participants’ adherence to the prescribed treatment and/or condom use during sexual intercourse and (ii) sexual behavior during the double-blind phase of the study. Four hundred MSM were enrolled in the trial. Every 2 months they completed online questionnaires collecting sexual behavior and PrEP adherence data regarding their most recent sexual intercourse. A total of 2232 questionnaires (M0–M24) were analyzed. Changes over time were evaluated using a mixed model accounting for multiple measures. Irrespective of sexual partner and practice type, on average, 42.6% (min: 32.1–max: 45.8%) reported PrEP use only during their most recent episode of sexual intercourse; 29% (22.9–35.6%) reported both PrEP and condom use; 11.7% (7.2–18.9%) reported condom-use only, and 16.7% (10.8–29.6%) reported no PrEP or condom use with no significant change during the study. Scheduled (i.e., correct) PrEP use was reported on average by 59.0% (47.2–68.5%) of those reporting PrEP use during their most recent sexual intercourse. Overall, 70.3% (65.3–79.4%) and 69.3% (58.3–75.4%) of participants reported, respectively, condomless anal and condomless receptive anal intercourse during their most recent sexual encounter without significant change during follow-up. Overall, on average 83.3% (min: 70.4–max: 89.2%) of participants protected themselves by PrEP intake or condom use or both during the trial, and no increase in at-risk sexual practices was observed. None of these indicators showed significant trend during the follow-up, although we found a tendency toward decrease (p = .19) of the median number of sexual partners strengthening the absence of behavioral disinhibition. On-demand PrEP within a comprehensive HIV prevention package could improve prevention in MSM.