Rectal Sexually Transmitted Infections Research Articles

Extragenital Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men in Johannesburg, South Africa.

In South Africa, extragenital etiological sexually transmitted infection (STI) screening among men who have sex with men (MSM) is not routinely available. We aimed to determine the prevalence of STI pathogens at rectal and pharyngeal sites, syphilis seroprevalence, and associated risk factors among a selection of high-risk MSM without symptomatic urethritis attending a men's health clinic in Johannesburg, South Africa. A cross-sectional study was conducted in 2022. Enrolled clients self-reported demographic, sexual behavioral risks, and clinical information. Client or clinician-collected rectal and pharyngeal swabs were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. C. trachomatis-positive rectal samples were reflex tested for lymphogranuloma venereum. Blood specimens were screened for syphilis. Univariate and multivariate regression models were used to determine factors independently associated with the presence of an extragenital STI or syphilis. Among the 97 participants (median age, 29 years), 24.7% had an extragenital STI and 9.4% had high nontreponemal antibody titers (rapid plasma reagin ≥1:16). Rectal STIs were detected in 26.4% participants: N. gonorrhoeae (14.3%), C. trachomatis (9.9%), and M. genitalium (5.5%). Pharyngeal STIs were less prevalent (4.1%). Overall, the prevalence of any STI was 41%. Sex under the influence of drugs (adjusted odds ratio, 4.94; 95% confidence interval, 1.56-15.69) and engaging in condomless receptive anal intercourse with a casual partner (adjusted odds ratio, 8.36; 95% confidence interval, 1.73-40.28) were independent risk factors for having an extragenital STI. The high burden of extragenital STIs and active syphilis in asymptomatic MSM underscores the importance of routine etiological screening in this key population, as the syndromic approach would not enable detection or treatment of these infections.

Preferences for Rectal Sexually Transmitted Infection Sample Collection and Sexual Behaviors Among Adolescent and Young Adult Women Accessing Primary Care Services.

High prevalence of asymptomatic rectal chlamydia and gonorrhea among women is increasingly recognized. Screening is controversial because of lack of natural history data. Barriers to screening may include reluctance to discuss anal sex and collect rectal samples. This study describes the prevalence of sexual contact exposing adolescent and young adult women to extragenital sexually transmitted infections and acceptability of self-collection and clinician collection of rectal samples, preference for self- versus clinician-collected rectal samples, and preference for home or doctor's office for sample collection. Participants were recruited from a primary care office and completed structured interviews assessing types of sexual contact and attitudes about rectal sampling. Differences were tested using χ2 and 2-sided Fisher exact test. Of 110 cisgender women (aged 14-22 years) enrolled, the average age was 18.4 years (SD, 1.7 years), 83% reported a history of extragenital contact, 22% reported history of receptive anal intercourse. A majority of participants reported self- and clinician-collected rectal samples to be acceptable (86% and 73%, respectively), with preferences for self-collection (71%) over clinician collection (29%, P < 0.001) and collection at the doctor's office (85%) over home (15%, P < 0.001). Adolescent and young adult (AYA) women engage in behaviors that increase the risk of rectal sexually transmitted infection (STI). Self- and clinician-collected rectal samples were acceptable. A majority of AYA women preferred to collect rectal samples in the doctor's office rather than at home. This may reduce adolescents' access to direct-to-consumer STI services. Offering in-clinic, self-collected rectal samples may improve uptake of rectal STI screening in adolescent girls.

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.

A retrospective study of HIV pre-exposure prophylaxis counselling among non-Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014-2019.

IntroductionYouth account for a disproportionate number of new HIV infections; however, pre‐exposure prophylaxis (PrEP) use is limited. We evaluated PrEP counselling rates among non‐Hispanic Black youth in the United States after a bacterial sexually transmitted infection (STI) diagnosis.MethodsWe conducted a retrospective cohort study of Black youth receiving care at two academically affiliated clinics in Philadelphia between June 2014 and June 2019. We compared PrEP counselling for youth who received primary care services versus those who did not receive primary care services, all of whom met PrEP eligibility criteria due to STI diagnosis per U.S. Centers for Disease Control and Prevention clinical practice guidelines. Two logistic regression models for receipt of PrEP counselling were fit: Model 1 focused on sexual and gender minority (SGM) status and Model 2 on rectal STIs with both models adjusted for patient‐ and healthcare‐level factors.ResultsFour hundred and sixteen patients met PrEP eligibility criteria due to STI based on sex assigned at birth and sexual partners. Thirty patients (7%) had documentation of PrEP counselling. Receipt of primary care services was not significantly associated with receipt of PrEP counselling in either Model 1 (adjusted OR (aOR) 0.10 [95% CI 0.01, 0.99]) or Model 2 (aOR 0.52 [95% CI 0.10, 2.77]). Receipt of PrEP counselling was significantly associated with later calendar years of STI diagnosis (aOR 6.80 [95% CI 1.64, 29.3]), assigned male sex at birth (aOR 26.2 [95% CI 3.46, 198]) and SGM identity (aOR 317 [95% CI 39.9, 2521]) in Model 1 and later calendar years of diagnosis (aOR 3.46 [95% CI 1.25, 9.58]), assigned male sex at birth (aOR 18.6 [95% CI 3.88, 89.3]) and rectal STI diagnosis (aOR 28.0 [95% CI 8.07, 97.5]) in Model 2. Fourteen patients (3%) started PrEP during the observation period; 12/14 (86%) were SGM primary care patients assigned male sex at birth.ConclusionsPrEP counselling and uptake among U.S. non‐Hispanic Black youth remain disproportionately low despite recent STI diagnosis. These findings support the need for robust investment in PrEP‐inclusive sexual health services that are widely implemented and culturally tailored to Black youth, particularly cisgender heterosexual females.

863. Pre-Exposure Prophylaxis (PrEP) Prescriptions among Individuals at High Risk for HIV in the United States, 2012-2018

BackgroundTo describe trends in emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) PrEP uptake in 2012-2018 and characterize high risk individuals who use PrEP.MethodsThe study identified individuals aged ≥ 15 years old with claims suggesting high risk for HIV infection in the IBM MarketScan® Commercial Claims and Multi-state Medicaid Databases. High risk was defined using ICD codes indicating high risk sexual behavior or rectal/repeated bacterial sexually transmitted infection (STI). The index date was defined as the earliest of the first high risk sexual behavior diagnosis, the first rectal bacterial STI diagnosis, or the second non-rectal bacterial STI diagnosis within 12 months. Individuals were considered PrEP users if they had at least one FTC/TDF PrEP prescription within 12 months of index date. Individuals with evidence of HIV prior to or within 30 days after PrEP initiation/index date were excluded. Comorbidities were assessed using a modified Charlson Comorbidity Index that excluded HIV/AIDS.ResultsFTC/TDF PrEP uptake increased from 0.1% to 7.3% among commercially insured individuals between 2012-2018, and from 0.01% to 0.5% among Medicaid insured individuals between 2012-2017. Individuals ≥ 35 years old had the largest increase in PrEP uptake (0.1% to 13.0%), while those 16-25 years old had the smallest increase (0.03% to 2.3%). The largest proportion of PrEP users across all years were aged 25-34 while the largest proportion of non-PrEP users were aged 18-24. Compared to PrEP users, a larger proportion of PrEP non-users were female (62.9% vs. 1.4%, p < 0.05) and blacks/African American (49.1% vs. 40.3%, p < 0.05). A larger proportion of PrEP users had a risk status of homosexual (46.6% vs. 1.5%, p < 0.05) or bisexual (3.9% vs. 0.8%, p < 0.05) behavior than non-PrEP users. PrEP users also had more comorbidities than non-users among individuals with Medicaid and were less likely to have fee-for-service insurance plans overall (p < 0.05).Table 1. Characteristics of people at high-risk for HIV who do vs. do not use FTC/TDF PrEP measured during the follow-up period ConclusionDespite an increase in FTC/TDF PrEP initiations, uptake was low, especially among young adults, women, heterosexuals and blacks/African Americans. Low initiation rates in these groups may illustrate that FTC/TDF PrEP is not meeting the needs of all high-risk individuals.Disclosures Mo Zhou, PhD, Merck & Co., Inc. (Consultant) Yan Song, PhD, Merck & Co., Inc. (Consultant) Emily Gao, MS, MPH, Merck & Co., Inc. (Consultant) Yohance Whiteside, PhD, MSPH, Merck & Co., Inc. (Employee) Emma Billmyer, BA, Merck & Co., Inc. (Consultant) James Signorovitch, PhD, Merck & Co., Inc. (Consultant)

High prevalence of rectal chlamydia among pregnant adolescents in La Romana, Dominican Republic warrants extragenital STI testing.

To our knowledge, there are no studies estimating the prevalence of extragenital sexually transmitted infections (STIs) among pregnant adolescents in the Caribbean. This study sought to fill this gap by assessing the prevalence and correlates of oral, genital, and rectal chlamydia (CT) among a sample of pregnant adolescents in La Romana, Dominican Republic. Two hundred pregnant youths, aged 15-24years, were recruited by systematic sampling during their first prenatal visit to a maternal care unit. A sociodemographic and behavioral questionnaire was administered and urine and oral/anal swabs were collected and tested for CT. Descriptive analyses and Fisher's exact tests were performed. The prevalence of oral, genital, and rectal CT was 6%, 15%, and 23%, respectively, although less than 5% of participants reported ever engaging in receptive anal intercourse. This discrepancy could be explained by autoinoculation, concurrent transmission during sex, undertreatment of rectal CT, or underreporting of anal sex. Almost half of CT infections would have been missed if only genital samples were collected, as current protocol dictates. More research is needed to understand sexual behaviors and rectal STI risk factors among heterosexual adolescent women. STI screening procedures for pregnant and sexually active adolescents should include routine testing of extragenital sites.

Multifactorial Correlates of Incident Bacterial Sexually Transmitted Infections Among Black Men Who Have Sex With Men Recruited in 6 US Cities (HIV Prevention Trials Network 061).

Black men who have sex with men are at a disproportionate risk for sexually transmitted infections (STI). Understanding the drivers of those disparities can lead to culturally tailored interventions. We aimed to characterize the incidence and correlates of STI among Black individuals from HIV Prevention Trials Network 061, a multicity cohort study conducted from 2009 to 2011 in the United States. We used Cox proportional hazards regression to estimate adjusted hazard ratios (aHRs) accounting for within-participant correlation over multiple follow-up visits (enrollment, 6 and 12 months). We examined correlates of incident rectal and urethral STI as well as incident syphilis. Among 1522 individuals, the incidences of urethral and rectal Neisseria gonorrhoeae infection were 1.0 (95% confidence interval, 0.6-1.8) and 4.6 (95% CI, 3.5-6.3) cases per 100 person-years, respectively. The incidences of urethral and rectal Chlamydia trachomatis infection were 2.5 (95% CI, 1.7-3.6) and 2.5 (95% CI, 1.7-3.7) cases per 100 person-years, respectively. The incidence of syphilis was 3.6 (95% CI, 2.7-4.9) cases per 100 person-years. Younger age was associated with increased odds of incident urethral (aHR, 5.1; 95% CI, 2.3-11.1) and rectal (aHR, 2.6; 95% CI, 1.6-4.3) STI. Diagnosis of a rectal STI at baseline (aHR, 2.3; 95% CI, 1.1-4.0) and use of saliva as lubricant (aHR, 1.7; 95% CI, 1.1-2.8) were associated with incident rectal STI. Diagnosis of syphilis at baseline was associated with incident syphilis during follow-up (aHR, 5.6; 95% CI, 2.5-12.2). Younger participants had the highest STI incidence. Use of saliva as lubricant may be a driver of rectal infection, which deserves further study.

Lubrication Practices and Receptive Anal Sex: Implications for STI Transmission and Prevention.

IntroductionImplications of lubricant use in men having sex with men (MSM) are poorly characterized, particularly associations with sexual behavior and rectal sexually transmitted infection (STI) risk.AimWe sought to clarify covariates associated with lubrication type including differing sexual preferences and rectal STI prevalence.MethodsPrimary English-speaking individuals ≥18 years old visiting San Francisco City Clinic (SFCC) between April and May of 2018 who endorsed lubricant use during receptive anal sex within the last 3 months were studied. Associations between lubrication type used and collected covariates were assessed using Kruskal-Wallis analysis of variance for continuous variables and Chi-squared test for categorical variables. We used logistic regression to examine the association between lubrication type and rectal STI test result.Main Outcome MeasuresRectal STI test positivity.ResultsFrom all enrolled participants, 179 completed the survey and endorsed use of a lubricant during receptive anal sex within the last 3 months. Silicone lubricant users had the most sexual partners in the last 3 months (13 [mean] ± 30 [SD], P= .0003) and were most likely to have a history of gonorrhea. Oil-based lubricant users had the most partners with whom they had receptive anal sex in the last 3 months (7 ± 6, P= .03). Water-based lubricant users most commonly used a condom in their last sexual encounter and had the fewest sexual partners in the last 3 months (4 ± 4, P= .0003). Spit/saliva lubricant use was associated with positive rectal STI result.ConclusionSilicone and oil-based lubricant users were more likely to report condomless receptive anal sex and to have a history of gonorrhea while spit/saliva lubricant use associated with positive rectal STI acquisition. Lee A, Gaither TW, Langston ME, et al. Lubrication Practices and Receptive Anal Sex: Implications for STI Transmission and Prevention. Sex Med 2021;9:100341.

HIV burden and correlates of infection among transfeminine people and cisgender men who have sex with men in Nairobi, Kenya: an observational study

Transgender people are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide, and culturally competent prevention and treatment services are often unavailable or inaccessible. Despite recent improvements in national HIV responses for many key populations in east Africa, evidence of effective responses informed by transgender sexual health needs is sparse. We aimed to assess gender identity among men and transgender people who have sex with men in Kenya, and to explore its associations with sexual health-related outcomes, risk behaviours, and uptake of HIV prevention and care interventions. We did a cross-sectional study in Nairobi, Kenya, and recruited adult cisgender men and transfeminine people who reported having sex with men, through respondent-driven sampling. Inclusion criteria were possession of a valid study coupon, being aged 18 years or older, having male sex assignment at birth or male gender identification currently, living within 50 km of Nairobi, and having had consensual anal or oral sexual activity with a man in the previous 12 months. Seed participants were identified by three community organisations that provide targeted health-care services to gay, bisexual, or other men who have sex with men (MSM) communities in Nairobi. We assessed gender identity, sociodemographics, sexual behaviour, and HIV prevention and care uptake, by self-completed survey. Participants were tested for HIV, syphilis, and rectal and urethral gonorrhoea and chlamydia. We compared prevalence of sexual health outcomes, risk behaviour, and HIV prevention and care service uptake among transfeminine and cisgender participants, using multivariable robust Poisson regression models, with gender identity as the independent variable. Between May 4 and Dec 8, 2017, we enrolled 618 participants. Six participants did not answer the questions on sex assigned at birth and gender identity and so were excluded from the analyses. 522 (sample-weighted percentage 86%) of 612 participants were classified as cisgender men, 70 (11%) as transfeminine, and three (<1%) as transmasculine. 17 participants (2%) did not identify as male, female, or transgender. Compared with cisgender men, transfeminine people were more likely to be HIV-positive (28 [41%] of 70 transfeminine vs 151 [25%] of 521 cisgender men; p=0·0009) and to report current symptoms consistent with a rectal STI (eight [16%] of 67 vs 38 [7%] of 518; p=0·014). Transfeminine people reported higher numbers of recent male sexual partners (22 [27%] of 70 transfeminine people reported four or more male sexual partners in the past 3 months vs 112 [13%] of 522 cisgender men; p=0·042) and were more likely to report condomless anal intercourse with men (43 [62%] of 70 vs 208 [39%] of 522; p=0·0009) and receptive anal intercourse (54 [76%] of 70 vs 252 [46%] of 522; p<0·0001) in the past 3 months, and transactional sex with men (42 [57%] of 69 vs 240 [42%] of 518; p=0·023) and experience of sexual assault (16 [23%] of 69 vs 65 [11%] of 520; p=0·019) in the past 12 months. Use of pre-exposure prophylaxis and post-exposure prophylaxis was low in both groups. Transfeminine people who have sex with men have a higher burden of HIV and associated risk behaviours compared with cisgender MSM in the same context, yet their uptake of prevention and care services is poor. Policies should acknowledge the specific needs of transfeminine people as distinct from cisgender MSM, and support health-care providers to address these needs. Evidence for HIV Prevention in Southern Africa (EHPSA), UK Aid.

Pre-exposure Prophylaxis Use and Detected Sexually Transmitted Infections Among Men Who Have Sex With Men in the United States-National HIV Behavioral Surveillance, 5 US Cities, 2017.

Men who have sex with men (MSM) using HIV pre-exposure prophylaxis (PrEP) may be at high risk for bacterial sexually transmitted infections (STIs). We examined the prevalence of extragenital gonorrhea and chlamydia by PrEP status among a multisite sample of US MSM. MSM aged ≥18 years were recruited through venue-based sampling to participate in the 2017 National HIV Behavioral Surveillance. In 5 cities (San Francisco, Washington DC, New York City, Miami, and Houston), participants completed a questionnaire, HIV testing, and pharyngeal and rectal STI specimen self-collection. We measured prevalence of pharyngeal and rectal gonorrhea and chlamydia among self-reported non-HIV-positive MSM who reported using or not using PrEP in the previous 12 months. Overall, 29.6% (481/1627) of non-HIV-positive MSM reported PrEP use in the past year. MSM who reported PrEP use were more likely to have any STI (ie, extragenital gonorrhea and/or chlamydia) than MSM not on PrEP [14.6% vs. 12.0%, adjusted prevalence ratio (aPR) = 1.5, 95% confidence interval (CI) : 1.1 to 2.0], reflecting differences in rectal chlamydia prevalence (8.7% vs. 6.0%, aPR = 1.6, 95% CI: 1.1 to 2.4). PrEP use was not associated with pharyngeal chlamydia, pharyngeal gonorrhea, or rectal gonorrhea. The prevalence of extragenital STI was high for both MSM on PrEP and those not on PrEP in the past year. MSM on PrEP were more likely to have rectal chlamydia but not pharyngeal STIs or rectal gonorrhea. Our findings support regular STI testing at exposed anatomic sites as recommended for sexually active MSM, including those on PrEP.

Sexually transmitted infection screening, prevalence and incidence among South African men and transgender women who have sex with men enrolled in a combination HIV prevention cohort study: the Sibanye Methods for Prevention Packages Programme (MP3) project.

IntroductionMen who have sex with men (MSM) and transgender women (TGW) experience high incidence and prevalence of sexually transmitted infections (STI), and data are needed to understand risk factors for STIs in these populations. The Sibanye Health Project was conducted in Cape Town and Port Elizabeth, South Africa from 2015 to 2016 to develop and test a package of HIV prevention interventions for MSM and TGW. We describe the incidence, prevalence and symptoms of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG) and syphilis observed during the study.MethodsParticipants completed HIV testing at baseline. All participants who were HIV negative were followed prospectively. Additionally, a sample of participants identified as living with HIV at baseline was selected to be followed prospectively so that the prospective cohort was approximately 20% HIV positive; the remaining participants identified as HIV positive at baseline were not followed prospectively. Prospective participants were followed for 12 months and returned for clinic‐based STI/HIV testing and assessment of STI symptoms at months 6 and 12. Additional HIV/STI testing visits could be scheduled at participant request.ResultsFollowing consent, a total of 292 participants attended a baseline visit (mean age = 26 years), and 201 were enrolled for the 12‐month prospective study. Acceptance of screening for syphilis and urethral NG/CT was near universal, though acceptance of screening for rectal NG/CT was lower (194/292; 66%). Prevalence of urethral CT and NG at baseline was 10% (29/289) and 3% (8/288) respectively; incidence of urethral CT and NG was 12.8/100 person‐years (PY) and 7.1/100 PY respectively. Prevalence of rectal CT and NG at baseline was 25% (47/189) and 16% (30/189) respectively; incidence of rectal CT and NG was 33.4/100 PY and 26.8/100 PY respectively. Prevalence of syphilis at baseline was 17% (45/258) and incidence was 8.2/100 PY. 91%, 95% and 97% of diagnosed rectal NG/CT, urethral NG/CT and syphilis infections, respectively, were clinically asymptomatic.ConclusionsPrevalence and incidence of urethral and rectal STIs were high among these South African MSM and TGW, and were similar to rates in other settings in the world. Clinical symptoms from these infections were rare, highlighting limitations of syndromic surveillance and suggesting the need for presumptive testing and/or treatment to address the STI epidemic among MSM/TGW in South Africa.

Gaps in Sexually Transmitted Infection Screening Among Men who Have Sex with Men in Pre-exposure Prophylaxis (PrEP) Care in the United States.

The US Centers for Disease Control and Prevention (CDC) recommends comprehensive sexually transmitted infection (STI) screening every 3-6 months for men who have sex with men (MSM) using human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP). The gaps between these recommendations and clinical practice by region have not been quantified. We used survey data collected from the internet-based ARTnet study between 2017 and 2019 on STI screening among MSM across the United States, stratified by current, prior, and never PrEP use. Poisson regression models with robust error variance were used to model factors, including residence in the Southeast, associated with consistent ("always" or "sometimes") exposure site-specific STI screening during PrEP care. Of 3259 HIV-negative MSM, 19% were currently using PrEP, 6% had used PrEP in the past, and 75% had never used PrEP. Among ever PrEP users, 87%, 78%, 57%, and 64% reported consistent screening for STIs by blood sample, urine sample or urethral swab, rectal swab, or pharyngeal swab, respectively, during PrEP care. Compared to PrEP users in all other regions, PrEP users in the Southeast were significantly less likely to be consistently screened for urogenital (adjusted prevalence ratio [aPR], 0.86; 95% confidence interval [CI], .76-.98) and rectal STIs (aPR, 0.76; 95% CI, .62-.93) during PrEP care. Substantial gaps exist between CDC recommendations for STI screening during PrEP care and current clinical practice, particularly for rectal and pharyngeal exposure sites that can harbor asymptomatic infections and for MSM in Southeast states where the STI burden is substantial.

Pubic Hair Grooming and Sexually Transmitted Infections: A Clinic-Based Cross-Sectional Survey.

Pubic hair grooming has been correlated with a self-reported history of sexually transmitted infections (STIs). We examined this relationship further in a cross-sectional survey of patients attending an urban STI clinic in San Francisco in 2018. Pubic hair grooming practices and detailed sexual histories were obtained. Sexually transmitted infections were confirmed via laboratory diagnosis or physical examination by a licensed provider. A total of 314 individuals completed the survey. The median age of participants was 31 years. In total, there were 247 (80%) men, 58 (19%) women, and 5 (2%) transgender participants. Of the 247 men, 177 (72%) identified as gay or bisexual. Twenty-five (82%) of 314 patients reported pubic hair grooming within the past 3 months. Seventy-eight (25%) patients were diagnosed with a new STI during their visit. There were no significant associations between reporting any anal or genital grooming and being diagnosed with an STI. However, anal groomers were 3 times as likely to be diagnosed with a rectal STI after adjustment (adjusted odds ratio, 3.0; 95% confidence interval, 1.2-7.5) compared with genital only groomers and nongroomers. Participants who report removing all of their pubic hair more than 6 times within the past year had higher prevalence of genital STIs (33.3%, 6-10 times; 28.6%, >10 times) compared with participants who never groom all of their pubic hair (15.3%, P = 0.01). We found no association between recent grooming and genital STIs. Anal grooming was associated with rectal STIs in gay and bisexual men.

Lack of sexual behavior disclosure may distort STI testing outcomes

BackgroundMen who have sex with men (MSM) globally have a high burden of curable sexually transmitted infections (STIs). MSM do not frequently receive rectal STI testing because of several barriers, such as not being out (disclosure of sexual behavior). We evaluate whether Chinese MSM select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive), and the interactions with being out.MethodsThis was a secondary analysis of data from a cross sectional MSM survey conducted at a multisite randomized controlled trial (RCT) (December 2018 to January 2019) around uptake of gonorrhea and chlamydia testing among Chinese MSM (N = 431). We collected socio demographics, relevant medical and sexual history, and disclosure of sexual behavior (outness). We estimated the decision to test and test choice, and the extent to which disclosure plays a role in decision making.ResultsAmong 431 MSM, mean age was 28 years (SD = 7.10) and 65% were out to someone. MSM who indicated versatile sexual behavior and were out to someone had a 26.8% (95%CI = 6.1, 47.5) increased likelihood for selecting the rectal test vs the ure thral test, compared to those versatile and not out. Versatile MSM out to their health provider outside of the study context had a 29.4% (95%CI = 6.3, 52.6) greater likelihood for selecting the rectal STI test vs the urethral test, compared to versatile MSM not out to their health provider.ConclusionsSexual behavior and outness may affect gonorrhea and chlamydia testing provision. Apart from clinicians, community based efforts may reduce stigma based barriers to testing.

Sexual Partnership-Level Correlates of Intimate Partner Violence Among Men Who Have Sex with Men and Transgender Women in Lima, Peru.

To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p < .01). Physical violence (4.5% MSM; 9.2% TW) was associated with stable partnerships (aPR 3.79, 95% CI 1.79-8.04), partner concurrency (4.42, 1.19-16.40), and participant alcohol (4.71, 1.82-12.17) or drug use (5.38, 2.22-13.02) prior to sex. Psychological violence (4.5% MSM; 5.0% TW) was associated with stable partnerships (2.84, 1.01-7.99). Sexual IPV was reported by 1.1% of MSM and 5.0% of TW. Physical, psychological, and sexual IPV were reported in sexual partnerships of Peruvian MSM and TW, particularly with stable partners and in conjunction with substance use.

Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis in men having sex with men in Port-au-Prince, Haiti: a cross-sectional study

ObjectivesOver the last 15 years, the prevalence of HIV in Haiti has stabilised to around 2.0%. However, key populations remain at higher risk of contracting HIV and other sexually transmitted...

423. Self-Reported Screening for Rectal Sexually Transmitted Infections Among Men Who Have Sex with Men

BackgroundRectal gonorrhea and Chlamydia are common and predict HIV acquisition among men who have sex with men (MSM); however, screening for rectal sexually transmitted infections (STIs) is not routine.MethodsIn 2017, we recruited sexually-active MSM in the Portland, Oregon metropolitan area through venue-based sampling. Our outcome of interest was self-reported rectal STI screening in the prior 12 months. Stratified by HIV status, we assessed the prevalence and demographic, healthcare, clinical, and behavioral predictors of screening.ResultsOf 448 participants, 168 (37.5%) reported rectal STI screening. One hundred twenty-seven (35.8%) of 355 HIV-negative men, 41 (58.6%) of 70 HIV-positive men, and none of 23 men who did not know their HIV status reported screening. Among HIV-negative men, having a healthcare provider who offered HIV testing (adjusted prevalence ratio [aPR]=2.09; 95% confidence interval [CI]: 1.43, 3.04), a syphilis diagnosis (aPR=1.32; 95% CI: 1.03, 1.69), use of pre-exposure prophylaxis (aPR=1.57; 95% CI 1.21, 2.04), and condomless anal sex with casual partners in the prior 12 months (aPR=1.74; 95% CI: 1.36, 2.22) independently predicted screening for rectal STI in multivariable analysis. HIV-positive men who reported having a provider who always or often initiates conversations about sex were significantly more likely to report screening compared with men who did not have such a provider (aPR=1.48; 95% CI: 1.06, 2.06).ConclusionRectal STI screening is not universal in a venue-based sample of sexually-active MSM. Implementing innovative, acceptable, and accessible screening practices and improving provider comfort with talking about sex are paramount to increasing rectal STI screening. Disclosures All authors: No reported disclosures.

Self-Reported Screening for Rectal Sexually Transmitted Infections Among Men Who Have Sex With Men.

Rectal gonorrhea and chlamydia are common and predict human immunodeficiency virus (HIV) acquisition among men who have sex with men (MSM); however, screening for rectal sexually transmitted infections (STIs) is not routine. In 2017, we recruited sexually active MSM in the Portland, Oregon metropolitan area through venue-based sampling. Our outcome of interest was self-reported rectal STI screening in the prior 12 months among those who had a health care visit in the same time period. Stratified by HIV status and preexposure prophylaxis (PrEP) use, we assessed the prevalence and predictors of screening. Of 403 participants, 162 (40.2%) reported rectal STI screening. Sixty (25.7%) of 233 HIV-negative men who did not report PrEP use in the prior 12 months; 61 (69.3%) of the 88 HIV-negative men who reported PrEP use in the prior 12 months; and, 41 (59.4%) of 69 men living with HIV-reported screening, respectively. Among HIV-negative men who did not report PrEP use in the prior 12 months, having a health care provider who offered HIV testing (adjusted prevalence ratio [aPR], 2.21; 95% confidence interval [CI], 1.38-3.52) and condomless anal sex with casual partners in the prior 12 months (aPR, 1.63; 95% CI, 1.01-2.65) were independently associated with rectal STI screening. The HIV-negative men on PrEP who had a syphilis diagnosis in the prior 12 months were more likely to be screened than those without syphilis (aPR, 1.33; 95% CI, 1.11-1.59). Men living with HIV who reported having a provider who always or often initiates conversations about sex were more likely to report screening compared with men who did not have such a provider (aPR, 1.46; 95% CI, 1.06-2.03). Rectal STI screening is not universal in a venue-based sample of sexually active MSM. Implementing innovative, acceptable, and accessible screening practices, enhancing health literacy around STI screening and improving provider comfort with talking about sex are paramount to increasing rectal STI screening.

P064 Receptive anal intercourse in patients with inflammatory bowel disease: The role of sexually transmitted infections

BACKGROUND: Receptive anal intercourse (RAI) is a common practice in both men who have sex with men (MSM) and heterosexual populations. While inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), affects over 1 million people in the United States, there have been no studies linking IBD and sexually transmitted infections (STIs). IBD can lead to an inflamed and leaky colonic epithelial barrier, which may increase the risk of rectal STI acquisition. The increased risk of HIV seroconversion in MSM with untreated rectal gonorrhea (GC) and chlamydia (CT) may support this theory. CASES: Our first case is of a 24-year-old MSM who was diagnosed with left-sided UC at age 21 in the setting of bloody diarrhea and tenesmus. He was originally treated with topical and oral 5-ASA, and topical steroids, but developed a mesalamine-associated rash and consequently discontinued these agents. At 24, the patient presented to clinic with recurrence of bloody diarrhea and tenesmus, and on questioning was found to engage in RAI. Rectal swab and enteric pathogen PCR panel revealed rectal gonorrhea and shigella. The patient was treated with ceftriaxone and azithromycin and symptoms completely resolved. Our second patient is a 23-year-old MSM male with UC from rectum to 50 cm who had achieved deep remission on adalimumab monotherapy, and presented with tenesmus, increased mucous, and a history of RAI. The patient tested positive for rectal CT and was treated with doxycycline. The patient’s symptoms resolved completely after treatment. DISCUSSION: Rectal STIs may complicate IBD. Underlying IBD, especially the presence of active proctitis and the utilization of immunosuppression, may increase susceptibility to STI acquisition via RAI. These cases indicate the importance of careful history taking and frequent rectal STI testing in IBD patients who engage in RAI. Future studies are required to continue to explore the influence of STIs on IBD patients who engage in RAI, including qualitative data on how IBD patients navigate RAI and STIs and quantitative data to gauge how prevalent STIs are in IBD patients compare to the general population.

Self-Reported Extragenital Chlamydia and Gonorrhea Testing in the Past 12 Months Among Men Who Have Sex with Men in the United States-American Men's Internet Survey, 2017.

Current guidelines recommend that sexually active men who have sex with men (MSM) be screened at least annually for bacterial sexually transmitted infections (STIs) at sites of sexual contact regardless of condom use. Extragenital (rectal and pharyngeal) STI are common in MSM and associated with an increased risk of human immunodeficiency virus. We describe the prevalence of MSM who reported any STI test and an extragenital STI test in the past 12 months (p12m) in the United States. Data were obtained from the 2017 American Men's Internet Survey, an annual cross-sectional behavioral internet survey of MSM in the United States. We examined the prevalence of MSM who reported any STI test and an extragenital STI test in the p12m and compared the prevalence across demographic, clinical, and behavioral factors. Of 10,049 sexually active MSM who participated in American Men's Internet Survey 2017, 42% reported any STI test in the p12m and 16% reported an extragenital (rectal or pharyngeal) STI test in the p12m. Among those who reported getting an extragenital STI test in the p12m, 19% reported providing a throat swab only, 14% reported providing a rectal swab only, and 68% reported providing both a rectal and throat swab for STI testing. In a large sample of internet-using MSM in the United States, levels of STI screening were suboptimal, with fewer than half (42%) of MSM reporting any STI test and even fewer reporting an extragenital STI test in the p12m. Increased efforts are needed to ensure annual STI screening guidelines among MSM are implemented.