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STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany.
BMC Infect Dis. 2020 Feb 07; 20(1):110.BI

Abstract

BACKGROUND

Men who have sex with men (MSM) are disproportionally affected by sexually transmitted infections (STI). STI are often extragenital and asymptomatic. Both can delay diagnosis and treatment. Approval of HIV pre-exposure prophylaxis (PrEP) might have influenced sexual behaviour and STI-prevalence of HIV- MSM. We estimated STI-prevalence and risk factors amongst HIV- and HIV+ MSM in Germany to plan effective interventions.

METHODS

We conducted a nationwide, cross-sectional study between February and July 2018. Thirteen MSM-friendly STI-practices screened MSM for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhea (NG), and Trichomonas vaginalis (TV) using self-collected rectal and pharyngeal swabs, and urine samples. APTIMA™ STI-assays (Hologic™ Inc., San Diego, USA) were used for diagnostics, and samples were not pooled. We collected information on socio-demographics, HIV-status, clinical symptoms, sexual behaviour within the last 6 months, and PrEP use. We combined HIV status and PrEP use for defining risk groups, and used directed acyclic graphs and multivariable logistic regression to identify risk factors for STI.

RESULTS

Two thousand three hundred three MSM were included: 50.5% HIV+, median age 39 [18-79] years. Median number of male sex partners within the last 6 months was five. Sex without condom was reported by 73.6%, use of party drugs by 44.6%. 80.3% had a STI history, 32.2% of STI+ MSM reported STI-related symptoms. 27.6% of HIV- MSM used PrEP. Overall STI-prevalence was 30.1, 25.0% in HIV-/PrEP- MSM (CT:7.2%; MG:14.2%; NG:7.4%; TV:0%), 40.3% in HIV-/PrEP+ MSM (CT:13.8%; MG:19.4%; NG:14.8%; TV:0.4%), and 30.8% in HIV+ MSM (CT:10.1%; MG:18.4%; NG:8.6%; TV:0.1%). Being HIV+ (OR 1.7, 95%-CI 1.3-2.2), using PrEP (OR 2.0, 95%-CI 1.5-2.7), having > 5 sex partners (OR:1.65; 95%-CI:1.32-2.01.9), having condomless sex (OR:2.11.9; 95%-CI:1.65-2.86), and using party drugs (OR:1.65; 95%-CI:1.32-2.0) were independent risk factors for being tested positive for at least one STI.

CONCLUSIONS

We found a high STI-prevalence in MSM in Germany, especially in PrEP users, frequently being asymptomatic. As a relevant proportion of PrEP users will not use a condom, counselling and comprehensive STI screening is essential and should be low threshold and preferably free of cost. Counselling of PrEP users should also address use of party drugs.

Authors+Show Affiliations

Robert Koch Institute, Unit for HIV/AIDS, STI and Blood-borne Infections, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353, Berlin, Germany. jansenk@rki.de.Robert Koch Institute, Unit for HIV/AIDS, STI and Blood-borne Infections, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353, Berlin, Germany. Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.Walk in Ruhr (WIR), Centre for Sexual Health and Medicine, Clinic of the Ruhr University, Bochum, Germany.Labor Krone/Labcon-OWL, Bad Salzuflen, Germany.Praxis/Labor Dr. med. Heribert Knechten, Aachen, Germany.Praxis Jessen2, Berlin, Germany.Praxis Hohenstaufenring, Köln, Germany.Department of Dermatology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.Robert Koch Institute, Unit for HIV/AIDS, STI and Blood-borne Infections, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353, Berlin, Germany.Labor Krone/Labcon-OWL, Bad Salzuflen, Germany.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32033533

Citation

Jansen, Klaus, et al. "STI in Times of PrEP: High Prevalence of Chlamydia, Gonorrhea, and Mycoplasma at Different Anatomic Sites in Men Who Have Sex With Men in Germany." BMC Infectious Diseases, vol. 20, no. 1, 2020, p. 110.
Jansen K, Steffen G, Potthoff A, et al. STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany. BMC Infect Dis. 2020;20(1):110.
Jansen, K., Steffen, G., Potthoff, A., Schuppe, A. K., Beer, D., Jessen, H., Scholten, S., Spornraft-Ragaller, P., Bremer, V., & Tiemann, C. (2020). STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany. BMC Infectious Diseases, 20(1), 110. https://doi.org/10.1186/s12879-020-4831-4
Jansen K, et al. STI in Times of PrEP: High Prevalence of Chlamydia, Gonorrhea, and Mycoplasma at Different Anatomic Sites in Men Who Have Sex With Men in Germany. BMC Infect Dis. 2020 Feb 7;20(1):110. PubMed PMID: 32033533.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany. AU - Jansen,Klaus, AU - Steffen,Gyde, AU - Potthoff,Anja, AU - Schuppe,Ann-Kathrin, AU - Beer,Daniel, AU - Jessen,Heiko, AU - Scholten,Stefan, AU - Spornraft-Ragaller,Petra, AU - Bremer,Viviane, AU - Tiemann,Carsten, AU - ,, Y1 - 2020/02/07/ PY - 2019/09/17/received PY - 2020/01/28/accepted PY - 2020/2/9/entrez PY - 2020/2/9/pubmed PY - 2020/4/9/medline KW - Chlamydia trachomatis KW - HIV KW - MSM KW - Mycoplasma genitalium KW - Neisseria gonorrhoeae KW - PrEP KW - Prevalence SP - 110 EP - 110 JF - BMC infectious diseases JO - BMC Infect Dis VL - 20 IS - 1 N2 - BACKGROUND: Men who have sex with men (MSM) are disproportionally affected by sexually transmitted infections (STI). STI are often extragenital and asymptomatic. Both can delay diagnosis and treatment. Approval of HIV pre-exposure prophylaxis (PrEP) might have influenced sexual behaviour and STI-prevalence of HIV- MSM. We estimated STI-prevalence and risk factors amongst HIV- and HIV+ MSM in Germany to plan effective interventions. METHODS: We conducted a nationwide, cross-sectional study between February and July 2018. Thirteen MSM-friendly STI-practices screened MSM for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhea (NG), and Trichomonas vaginalis (TV) using self-collected rectal and pharyngeal swabs, and urine samples. APTIMA™ STI-assays (Hologic™ Inc., San Diego, USA) were used for diagnostics, and samples were not pooled. We collected information on socio-demographics, HIV-status, clinical symptoms, sexual behaviour within the last 6 months, and PrEP use. We combined HIV status and PrEP use for defining risk groups, and used directed acyclic graphs and multivariable logistic regression to identify risk factors for STI. RESULTS: Two thousand three hundred three MSM were included: 50.5% HIV+, median age 39 [18-79] years. Median number of male sex partners within the last 6 months was five. Sex without condom was reported by 73.6%, use of party drugs by 44.6%. 80.3% had a STI history, 32.2% of STI+ MSM reported STI-related symptoms. 27.6% of HIV- MSM used PrEP. Overall STI-prevalence was 30.1, 25.0% in HIV-/PrEP- MSM (CT:7.2%; MG:14.2%; NG:7.4%; TV:0%), 40.3% in HIV-/PrEP+ MSM (CT:13.8%; MG:19.4%; NG:14.8%; TV:0.4%), and 30.8% in HIV+ MSM (CT:10.1%; MG:18.4%; NG:8.6%; TV:0.1%). Being HIV+ (OR 1.7, 95%-CI 1.3-2.2), using PrEP (OR 2.0, 95%-CI 1.5-2.7), having > 5 sex partners (OR:1.65; 95%-CI:1.32-2.01.9), having condomless sex (OR:2.11.9; 95%-CI:1.65-2.86), and using party drugs (OR:1.65; 95%-CI:1.32-2.0) were independent risk factors for being tested positive for at least one STI. CONCLUSIONS: We found a high STI-prevalence in MSM in Germany, especially in PrEP users, frequently being asymptomatic. As a relevant proportion of PrEP users will not use a condom, counselling and comprehensive STI screening is essential and should be low threshold and preferably free of cost. Counselling of PrEP users should also address use of party drugs. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/32033533/STI_in_times_of_PrEP:_high_prevalence_of_chlamydia_gonorrhea_and_mycoplasma_at_different_anatomic_sites_in_men_who_have_sex_with_men_in_Germany_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-4831-4 DB - PRIME DP - Unbound Medicine ER -