Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Sex Transm Dis. 2012 Mar;39(3):191-4. doi: 10.1097/OLQ.0b013e3182401a2f.
BACKGROUND: Human immunodeficiency virus (HIV) seroadaptive behaviors, such as serosorting and strategic positioning, are being increasingly practised by homosexual men; however, their impact on sexually transmissible infections is unclear. METHODS: Participants were 1427 initially HIV-negative men enrolled from 2001 to 2004 and followed to June 2007. Participants were tested annually for anal and urethral gonorrhoea and chlamydia, herpes simplex virus, and syphilis. In addition, they reported diagnoses of these conditions, and of genital and anal warts between annual visits, and sexual risk behaviors. RESULTS: Compared with men who reported no unprotected anal intercourse (UAI), serosorting was associated with an increased risk of urethral (incidence: 6.06 vs. 3.56 per 100 person-years (PY), hazard ratio (HR) = 1.97, 95% confidence interval [CI]: 1.43-2.72) and anal (incidence 3.95 vs. 2.80 per 100 PY, HR = 1.62, 95% CI: 1.11-2.36) chlamydia. Compared with men who reported UAI with HIV nonconcordant partners, men who practised serosorting had significantly lower risk of incident syphilis (incidence 0.18 vs. 1.00 per 100 PY, HR = 0.21, 95% CI: 0.05-0.81) and urethral gonorrhoea (incidence 2.15 vs. 5.52 per 100 PY, HR = 0.61, 95% CI: 0.39-0.96). Compared with men who reported no UAI, strategic positioning was associated with an increased risk of urethral gonorrhoea (incidence 4.11 vs. 2.10 per 100 PY, HR = 1.72, 95% CI: 1.05-2.83) and chlamydia (incidence 8.71 vs. 3.56 per 100 PY, HR = 2.22, 95% CI: 1.55-3.18). Compared with men who reported receptive UAI, the incidence of anal gonorrhoea (incidence 1.48 vs. 3.83 per 100 PY, HR = 0.38, 0.20-0.74) and chlamydia (incidence 3.10 vs. 6.30 per 100 PY, HR = 0.44, 95% CI: 0.27-0.69) was significantly lower in those who practised strategic positioning. CONCLUSION: For men who reported seroadaptive behaviors, rates of some bacterial sexually transmissible infections were higher than in men who reported no UAI. However, rates were lower than for men who reported higher HIV risk behaviors.
背景：人类免疫缺陷病毒（HIV）血清适应行为，如血清匹配和策略定位，越来越多地被男同性恋者采用；然而，它们对性传播感染的影响尚不清楚。
方法：参与者为 2001 年至 2004 年间招募的 1427 名最初 HIV 阴性男性，并随访至 2007 年 6 月。参与者每年接受肛门和尿道淋病和衣原体、单纯疱疹病毒和梅毒检测。此外，他们在每年就诊期间报告这些疾病的诊断情况，以及生殖器和肛门疣的诊断情况，并报告性行为风险。
结果：与报告没有无保护肛交（UAI）的男性相比，血清匹配与尿道（发病率：6.06 比 3.56/100 人年，危险比（HR）=1.97，95%置信区间[CI]：1.43-2.72）和肛门（发病率 3.95 比 2.80/100 人年，HR = 1.62，95%CI：1.11-2.36）衣原体的发病率增加有关。与报告与 HIV 不一致的伴侣发生 UAI 的男性相比，进行血清匹配的男性患梅毒（发病率 0.18 比 1.00/100 人年，HR = 0.21，95%CI：0.05-0.81）和尿道淋病（发病率 2.15 比 5.52/100 人年，HR = 0.61，95%CI：0.39-0.96）的风险显著降低。与报告没有 UAI 的男性相比，策略定位与尿道淋病（发病率 4.11 比 2.10/100 人年，HR = 1.72，95%CI：1.05-2.83）和衣原体（发病率 8.71 比 3.56/100 人年，HR = 2.22，95%CI：1.55-3.18）的发病率增加有关。与报告接受性 UAI 的男性相比，肛门淋病（发病率 1.48 比 3.83/100 人年，HR = 0.38，0.20-0.74）和衣原体（发病率 3.10 比 6.30/100 人年，HR = 0.44，95%CI：0.27-0.69）的发病率显著降低。
结论：对于报告血清适应行为的男性，一些细菌性性传播感染的发病率高于报告没有 UAI 的男性。然而，这些发病率低于报告 HIV 风险行为较高的男性。
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