Trends in asymptomatic STI among HIV-positive MSM and lessons for systematic screening

Abstract

The burden of STIs is particularly high in HIV-infected MSM patients. A recent increase in STIs prevalence has been noticed in the US and western European countries. We aim to assess trends in asymptomatic STIs following the publication of recommendations for STIs screening, i.e. Chlamydia (CT) and gonorrhea (NG). Seventeen centers located in the Paris area participated in the study. All asymptomatic HIV-infected MSM patients attending a follow up consultation were proposed to participated in the study. Asymptomatic patients were included over 2 periods: period 1 from April to December 2015 and period 2 from September to December 2017. Etiologic diagnosis of STIs including hepatitis B, C, syphilis, was performed using a serological test, including a non-treponemal titer with a confirmatory treponemal assay for syphilis. CT and NG were screened using a nucleic acid amplification test (NAATs) on 3 anatomical sites, i.e. urine, rectal and pharyngeal. Overall, 781 patients were included: 490 and 291 in periods 1 and 2 respectively. Asymptomatic CT, NG, and syphilis were diagnosed in 7.5%, 4.8% and, 4.2% respectively. The rate of patients having a multisite asymptomatic infection was 10.2% and 21.1% for CT and NG respectively. The most frequently involved anatomical sites for CT and NG asymptomatic infections were anorectal (66.1% and 55.2% respectively) and pharyngeal (47.4% and 60.5% respectively). CT and NG asymptomatic infection increased by 1.3- and 2-fold respectively between the two periods while syphilis decreased by 3 folds. Our results encourage to reconsider multisite screening for CT and NG in asymptomatic HIV positive MSM as the yield of screening urinary samples only might be low. Despite the more systematic STI screening of asymptomatic HIV positive MSM the prevalence of STI is increasing in MSM in France. Therefore, this strategy has not led to alter CT and NG transmission. The decrease of syphilis might involve self-medication by doxycycline, and the intensification of syphilis screening.

Spatio‐temporal changes in pre‐exposure prophylaxis uptake among MSM in mainland France between 2016 and 2021: a Bayesian small area approach with MSM population estimation

“…Third, we applied the EMIS‐2017‐based psychosocial determinants for all periods included, assuming these determinants were stable and comparable between 2016S1 and 2021S1. Given the established increasing trends of some of the included determinants, such as the STIs incidence [ 39 ], CAI [ 40 ] and chemsex [ 41 ], our estimations may be underestimated. Finally, due to a wording issue in the French‐language version (possible confound between STI testing and diagnosis) of EMIS‐2017, we extrapolated the proportion of MSM with an STI diagnosis in the preceding 5‐year from participants in France completing the survey in languages other than French [ 27 ].…”

Comparison of the burden of self-reported bacterial sexually transmitted infections among men having sex with men across 68 countries on four continents

“…However, extragenital testing and the use of less sensitive tests should play a minor role in the differences observed for symptomatic gonorrhea because most pharyngeal and rectal infections with gonorrhea are asymptomatic or present with hardly noticeable symptoms [44][45][46]; less sensitive tests are usually reactive in symptomatic infections. The effects of syndromic approaches to diagnosis and treatment are less predictable.…”

Coinfection With Chlamydial and Gonorrheal Infection Among US Adults With Early Syphilis

“…In contrast, testing for other common and reportable bacterial STIs (NG/CT) requires swab or urine collection, and some clinics default to urine STI testing only for simplicity. Screening rates for mucosal NG/CT (particularly at extragenital sites) tend to lag behind syphilis screening rates in MSM and people living with HIV despite the fact that rectal STI screening is high yield 17–19 . Screening based on exposure site is limited if patients are reluctant to disclose information about sexual practice or if providers do not ask about exposure sites as part of a complete sexual history.…”