Repeat rectal gonorrhoea in MSM increases HIV risk, independent of other STIs

  • Harney BL & al.
  • Open Forum Infect Dis
  • 1 Oct 2019

  • International Clinical Digest
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Takeaway

  • Cumulative rectal gonorrhoea infection history increases subsequent HIV infection risk in men who have sex with men (MSM), independent of other sexually transmitted infections (STIs), sexual behaviours.

Why this matters

  • Use STIs in MSM patients as prompt for HIV preexposure prophylaxis (PrEP).
  • Ensure counselling among MSM with history of STIs, especially repeated rectal gonorrhoea, reporting poor adherence or stopped PrEP.

Key results

  • 22,815 test events in 8941 MSM included.
  • 2.5% (227) received HIV diagnoses.
  • 3.7% (849) positive rectal gonorrhoea infections in 718 MSM; 6.9% (613), 1.2% (105) were diagnosed 1 time, >1 time, respectively.
  • Among MSM with repeat infections, majority had 2 rectal chlamydia (81%), rectal gonorrhoea (83%), syphilis (90%).
  • HIV risk higher for ≥2 prior rectal gonorrhoea diagnoses (aHR, 6.27; P<.001 prior vs msm with no rectal gonorrhoea.>
  • Inconsistent condom use (aHR, 1.83; P<.001 partners in last months increased hiv risk.>

Study design

  • Retrospective sentinel surveillance high caseload HIV data analysis of relationship between cumulative STIs, having an STI at prior test event, and risk of subsequent infection among Australian MSM during 2007-2014.
  • Funding: Victorian Department of Health and Human Services.

Limitations

  • Unmeasured confounders.
  • Limited generalisability.
  • Methodology.

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