In the Journals

Rectal gonorrhea associated with increased HIV infection risk in MSM

An Australian study that enrolled initially HIV-negative men who have sex with men, or MSM, showed that repeated and single rectal gonorrhea infections were associated with an increased risk for HIV infection, suggesting that preventive interventions be emphasized among MSM with a history of rectal gonorrhea, researchers said.

“Over recent decades, HIV notifications among MSM have increased in many high-income countries and this has occurred in conjunction with increased notifications of bacterial sexually transmissible infections (STIs) in a number of countries including Australia,” Brendan L. Harney, a research assistant in the Disease Elimination Program at the Burnet Institute, and colleagues wrote.

“Australia wide, in 2016, 75% of the HIV notifications were among MSM and in the state of Victoria, the 312 HIV notifications made in 2016 represented an 18% increase since 2007. Additionally, there has been an increase in bacterial STI notifications with the 6,328 gonorrhea and 1,138 syphilis notifications made in 2016 representative of an approximate sixfold increase in gonorrhea and almost threefold increase in syphilis notifications compared to 2007.”

According to the study, despite national guidelines recommending HIV and STI testing up to four times per year for HIV-negative MSM who report condomless anal sex and/or report more than 10 partners in 6 months, previous studies have shown quarterly HIV testing to be uncommon among MSM reporting these behaviors.

Harney and colleagues aimed to understand the elevated HIV risk among this population by analyzing data from HIV negative MSM who attended high HIV caseload primary care clinics in Melbourne, Australia from 2007 to 2014 with two or more HIV and STI tests.

In total, 227 (2.5%) of the 8,941 MSM included in the study were diagnosed with HIV during the follow-up period, according to Harney and colleagues. After adjusting for sexual behaviors, researchers found that a history of repeated rectal gonorrhea infections (adjusted HR = 6.27, 95% CI, 2.68-14.50) and a single rectal gonorrhea infection (aHR = 2.09. 95% CI, 1.15-3.79) were associated with increased HIV infection risk.

“There is limited understanding of the long-term impact of repeated bacterial STIs on HIV infection risk among MSM. Using data from high HIV caseload clinics, we found a cumulated history of rectal gonorrhea infection increased risk of subsequent HIV infection among MSM, and this relationship was independent of other STI diagnoses and sexual behaviors,” the authors concluded. “These findings suggest that MSM with a history of rectal gonorrhea, and particularly repeated rectal gonorrhea infection, represent a high-risk group for HIV infection and further support STIs as a marker of MSM who should [be] offered HIV [pre-exposure prophylaxis].” – by Caitlyn Stulpin

Disclosures: Harney reports no relevant financial disclosures. Please see the study for all other authors’ disclosures.

An Australian study that enrolled initially HIV-negative men who have sex with men, or MSM, showed that repeated and single rectal gonorrhea infections were associated with an increased risk for HIV infection, suggesting that preventive interventions be emphasized among MSM with a history of rectal gonorrhea, researchers said.

“Over recent decades, HIV notifications among MSM have increased in many high-income countries and this has occurred in conjunction with increased notifications of bacterial sexually transmissible infections (STIs) in a number of countries including Australia,” Brendan L. Harney, a research assistant in the Disease Elimination Program at the Burnet Institute, and colleagues wrote.

“Australia wide, in 2016, 75% of the HIV notifications were among MSM and in the state of Victoria, the 312 HIV notifications made in 2016 represented an 18% increase since 2007. Additionally, there has been an increase in bacterial STI notifications with the 6,328 gonorrhea and 1,138 syphilis notifications made in 2016 representative of an approximate sixfold increase in gonorrhea and almost threefold increase in syphilis notifications compared to 2007.”

According to the study, despite national guidelines recommending HIV and STI testing up to four times per year for HIV-negative MSM who report condomless anal sex and/or report more than 10 partners in 6 months, previous studies have shown quarterly HIV testing to be uncommon among MSM reporting these behaviors.

Harney and colleagues aimed to understand the elevated HIV risk among this population by analyzing data from HIV negative MSM who attended high HIV caseload primary care clinics in Melbourne, Australia from 2007 to 2014 with two or more HIV and STI tests.

In total, 227 (2.5%) of the 8,941 MSM included in the study were diagnosed with HIV during the follow-up period, according to Harney and colleagues. After adjusting for sexual behaviors, researchers found that a history of repeated rectal gonorrhea infections (adjusted HR = 6.27, 95% CI, 2.68-14.50) and a single rectal gonorrhea infection (aHR = 2.09. 95% CI, 1.15-3.79) were associated with increased HIV infection risk.

“There is limited understanding of the long-term impact of repeated bacterial STIs on HIV infection risk among MSM. Using data from high HIV caseload clinics, we found a cumulated history of rectal gonorrhea infection increased risk of subsequent HIV infection among MSM, and this relationship was independent of other STI diagnoses and sexual behaviors,” the authors concluded. “These findings suggest that MSM with a history of rectal gonorrhea, and particularly repeated rectal gonorrhea infection, represent a high-risk group for HIV infection and further support STIs as a marker of MSM who should [be] offered HIV [pre-exposure prophylaxis].” – by Caitlyn Stulpin

Disclosures: Harney reports no relevant financial disclosures. Please see the study for all other authors’ disclosures.