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Multicenter Study
. 2020 Feb 7;20(1):110.
doi: 10.1186/s12879-020-4831-4.

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

Klaus Jansen  1 , Gyde Steffen  2   3   4 , Anja Potthoff  5 , Ann-Kathrin Schuppe  6 , Daniel Beer  7 , Heiko Jessen  8 , Stefan Scholten  9 , Petra Spornraft-Ragaller  10 , Viviane Bremer  2 , Carsten Tiemann  6 ; MSM Screening Study group
Collaborators, Affiliations
Multicenter Study

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

Klaus Jansen et al. BMC Infect Dis. .

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.

Keywords: Chlamydia trachomatis; HIV; MSM; Mycoplasma genitalium; Neisseria gonorrhoeae; PrEP; Prevalence.

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Conflict of interest statement

Heiko Jessen received funding from Gilead Sciences GmbH and U.S. Military HIV Research Program (MHRP); for Board membership from ViiV Healthcare GmbH and MSD GmbH; for speaker activities from ViiV Healthcare GmbH, Janssen-Cilag GmbH and Hormosan Pharma GmbH; and for travel/accommodation/meeting expenses from Gilead Sciences GmbH Janssen-Cilag GmbH, ViiV Healthcare GmbH and MSD GmbH. Klaus Jansen is an Editorial Board Member for BMC Infectious Diseases.

Figures

Fig. 1
Fig. 1
Geographical distribution of study sites of the MSM Screening Study (map authors' own)
Fig. 2
Fig. 2
Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium, by HIV/PrEP-status (n = 2303)
Fig. 3
Fig. 3
Prevalence of any STI, by anatomical location and HIV/PrEP-Status (n = 2303)
See this image and copyright information in PMC

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