HIV Epidemiology and Prevention Program, The Kirby Institute, Sydney, New South Wales, Australia
Ambrose King Centre, Barts Health NHS Trust, London, UK.
Sex Transm Infect. 2019 Nov;95(7):477-483. doi: 10.1136/sextrans-2019-054011. Epub 2019 Apr 24.
Sexually transmitted infection (STI) notifications are increasing among older individuals. Many older gay and bisexual men (GBM) are sexually active and have multiple partners. We aimed to investigate the prevalence, incidence and predictors of anal chlamydia, anal gonorrhoea and syphilis in older GBM.
The Study for the Prevention of Anal Cancer (SPANC) was a prospective cohort study of HPV infections and related anal lesions among community-recruited GBM age ≥ 35 years in Sydney, Australia. At baseline and subsequent annual visits, recent STI diagnoses were collected via questionnaire ('interval diagnoses') and STI testing occurred ('study visit diagnoses'). Baseline STI prevalence was calculated using study visit diagnoses. Incidence of anal chlamydia and gonorrhoea was calculated using interval and study visit diagnoses. Syphilis incidence was calculated using interval diagnoses. Univariate and multivariate analysis using Cox proportional hazards were undertaken to investigate the association between risk factors and incident STI.
Among 617 GBM, the median age was 49 years (range 35-79) and 35.8% (n=221) were HIV-positive. At baseline, STI prevalence was: anal chlamydia 2.3% (n=14); anal gonorrhoea 0.5% (n=3) and syphilis 1.0% (n=6). During 1428 person-years of follow-up (PYFU), the incidence (per 100 PYFU) of anal chlamydia, anal gonorrhoea and syphilis was 10.40 (95% CI 8.82 to 12.25), 9.11 (95% CI 7.64 to 10.85) and 5.47 (95% CI 4.38 to 6.84), respectively. In multivariate analysis, HIV-positivity, higher number of recent condomless receptive anal intercourse partners and baseline methamphetamine use were associated with each STI. Sex with 'fuck-buddies' was associated with anal chlamydia and gonorrhoea. Age was not associated with any STI.
There was a high incidence of STI among SPANC participants. Age should not be used as a proxy for sexual risk and older GBM require a detailed sexual behaviour and recreational drug use history. Interventions that specifically target STI risk among older GBM should be considered.
性传播感染（STI）在老年人中的报告病例正在增加。许多老年男同性恋和双性恋者（GBM）仍有性生活且性伴侣较多。我们旨在研究老年 GBM 人群中肛门衣原体、肛门淋病和梅毒的流行率、发病率和预测因素。
预防肛门癌研究（SPANC）是在澳大利亚悉尼对社区招募的年龄≥35 岁的 GBM 中进行的 HPV 感染和相关肛门病变的前瞻性队列研究。在基线和随后的年度访视中，通过问卷（“间隔诊断”）收集最近的 STI 诊断，并且进行 STI 检测（“研究访视诊断”）。使用研究访视诊断计算基线 STI 患病率。使用间隔和研究访视诊断计算肛门衣原体和淋病的发病率。使用间隔诊断计算梅毒发病率。使用 Cox 比例风险进行单变量和多变量分析，以调查危险因素与新发 STI 之间的关联。
在 617 名 GBM 中，中位年龄为 49 岁（范围 35-79），35.8%（n=221）为 HIV 阳性。在基线时，STI 的患病率为：肛门衣原体 2.3%（n=14）；肛门淋病 0.5%（n=3）和梅毒 1.0%（n=6）。在 1428 人年的随访期间（PYFU），肛门衣原体、肛门淋病和梅毒的发病率（每 100 PYFU）分别为 10.40（95%CI8.82-12.25）、9.11（95%CI7.64-10.85）和 5.47（95%CI4.38-6.84）。多变量分析显示，HIV 阳性、近期无保护肛交性伴侣数量较多和基线时使用冰毒与每种 STI 相关。与“炮友”发生性关系与肛门衣原体和淋病有关。年龄与任何 STI 均无关。
SPANC 参与者中 STI 的发病率很高。年龄不应作为性行为风险的替代指标，老年 GBM 需要详细的性行为和娱乐性药物使用史。应考虑针对老年 GBM 中 STI 风险的专门干预措施。
