Gonorrhoea infection, reinfection and co‐infection in men in inner Sydney: a population‐based analysis

Ressler, Kelly‐Anne; Ferson, Mark J; Smedley, Elizabeth J

doi:10.5694/mja13.10945

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…20 Second, self-reporting and recall bias may have occurred in this retrospective study that requires recall of sexual activities in the last 12 months. First, this is a retrospective analysis of records from a single urban sexual health clinic, and the findings may not be representative of changes in prevalence and behaviors among MSM on a community level in Victoria or Australia.…”

Section: Discussionmentioning

confidence: 98%

Substantial Increases in Chlamydia and Gonorrhea Positivity Unexplained by Changes in Individual-Level Sexual Behaviors Among Men Who Have Sex With Men in an Australian Sexual Health Service From 2007 to 2013

Chow¹,

Tomnay²,

Fehler

et al. 2015

Sexually Transmitted Diseases

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Section: Discussionmentioning

confidence: 98%

Substantial Increases in Chlamydia and Gonorrhea Positivity Unexplained by Changes in Individual-Level Sexual Behaviors Among Men Who Have Sex With Men in an Australian Sexual Health Service From 2007 to 2013

Chow¹,

Tomnay²,

Fehler

et al. 2015

Sexually Transmitted Diseases

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“…In Australia, the US, and the United Kingdom, increasing trends in notifications of STI diagnoses were observed over several years before PrEP being broadly available, including in MSM populations. [8][9][10][11][12][13] Furthermore, increased frequency of STI testing, particularly that associated with PrEP, may also lead to an increase in STI diagnoses even if incidence is not increasing. 14 In New South Wales, Australia, between 2016 and 2018, a large-scale PrEP access program (Expanded PreEP Implementation in Communities in New South Wales [EPIC-NSW]) rapidly rolled out PrEP to almost 10 000 MSM at high risk of HIV infection.…”

Section: Introductionmentioning

confidence: 99%

“…A 2019 meta-analysis of epidemiological characteristics of STIs in PrEP users found high pooled prevalence of STI at initiation (23.9% [95% CI, 18.6%-29.6%]) and high pooled incidence during PrEP (72.2 cases per 100 person-years [95% CI, 60.5-86.2 cases per 100 person-years]). In Australia, the US, and the United Kingdom, increasing trends in notifications of STI diagnoses were observed over several years before PrEP being broadly available, including in MSM populations . Furthermore, increased frequency of STI testing, particularly that associated with PrEP, may also lead to an increase in STI diagnoses even if incidence is not increasing …”

Section: Introductionmentioning

confidence: 99%

Comparison of Trends in Rates of Sexually Transmitted Infections Before vs After Initiation of HIV Preexposure Prophylaxis Among Men Who Have Sex With Men

et al. 2020

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IMPORTANCEThere have been concerns that HIV preexposure prophylaxis (PrEP) may be associated with increases in sexually transmitted infections (STIs) because of subsequent reductions in condom use and/or increases in sexual partners. OBJECTIVE To determine trends in STI test positivity among high-risk men who have sex with men (MSM) before and after the start of HIV PrEP. DESIGN, SETTING, AND PARTICIPANTSA before-after analysis was conducted using a subcohort of a single-group PrEP implementation study cohort in New South Wales, Australia (Expanded PreEP Implementation in Communities in New South Wales [EPIC-NSW]), from up to 1 year before enrollment if after January 1, 2015, and up to 2 years after enrollment and before December 31, 2018. STI testing data were extracted from a network of 54 sexual health clinics and 6 primary health care clinics Australia-wide, using software to deidentify, encrypt, and anonymously link participants between clinics. A cohort of MSM dispensed PrEP for the first time during the study, with 2 or more STI tests in the prior year and who tested during follow-up, were included from the EPIC-NSW cohort of HIV-negative participants with high-risk sexual behavior. Data analysis was performed from June to December 2019. EXPOSURES Participants were dispensed coformulated tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) as HIV PrEP. MAIN OUTCOMES AND MEASURESThe main outcome was STI, measured using test positivity, defined as the proportion of participants testing positive for an STI at least once per quarter of follow-up. Outcomes were calculated for Chlamydia trachomatis and Neisseria gonorrhoea by site of infection (anorectal, pharyngeal, urethral, or any) and for syphilis. RESULTSOf the EPIC-NSW cohort of 9709 MSM, 2404 were included in the before-after analysis.The mean (SD) age of the participants was 36 (10.4) years, and 1192 (50%) were Australia-born. STI positivity was 52% in the year after PrEP (23.3% per quarter; 95% CI, 22.5%-24.2% per quarter) with no significant trend (mean rate ratio [RR] increase of 1.01 per quarter [95% CI, 0.99-1.02]; P = .29), compared with 50% positivity in the year prior to PrEP (20.0% per quarter [95% CI, 19.04%-20.95% per quarter]; RR for overall STI positivity, 1.17 [95% CI, 1.10-1.24]; P < .001), with an increase in quarterly STI positivity (mean RR of 1.08 per quarter, or an 8% increase per quarter [95% CI, 1.05-1.11]; P < .001; RR, 0.93 [95% CI, 0.90-0.96]; P < .001). Findings were similar when stratified by specific STIs and anatomical site. (continued) Key Points Question Is access to HIV preexposure prophylaxis (PrEP) associated with the trajectory of preexisting trends in sexually transmitted infections (STIs) among high-risk men who have sex with men (MSM)? Findings In a before-after cohort study of high-risk MSM participating in a population-based PrEP implementation project, STI positivity was high while men were taking PrEP with no increasing trend in quarterly STI positivity, compared with similar high positivity before P...

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“…For gonorrhoea, screening guidelines vary by setting, with recommendations to offer testing in remote Aboriginal communities, or based on local prevalence. 7 Chlamydia and gonorrhoea are known to co-occur, 8,9 providing support for joint testing, as well as syndromic treatment for both infections unless one is excluded. Pathology laboratories in Australia have increasingly adopted diagnostic platforms that test simultaneously for the two infections using nucleic acid detection methods.…”

Section: Introductionmentioning

confidence: 99%

Gonorrhoea testing and positivity in non-remote Aboriginal Community Controlled Health Services

Harrod¹,

Couzos

Ward

et al. 2017

Sex. Health

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Gonorrhoea infection, reinfection and co‐infection in men in inner Sydney: a population‐based analysis

Cited by 5 publications

References 5 publications

Substantial Increases in Chlamydia and Gonorrhea Positivity Unexplained by Changes in Individual-Level Sexual Behaviors Among Men Who Have Sex With Men in an Australian Sexual Health Service From 2007 to 2013

Substantial Increases in Chlamydia and Gonorrhea Positivity Unexplained by Changes in Individual-Level Sexual Behaviors Among Men Who Have Sex With Men in an Australian Sexual Health Service From 2007 to 2013

Comparison of Trends in Rates of Sexually Transmitted Infections Before vs After Initiation of HIV Preexposure Prophylaxis Among Men Who Have Sex With Men

Gonorrhoea testing and positivity in non-remote Aboriginal Community Controlled Health Services

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