Robert Koch Institute, Unit for HIV/AIDS, STI and Blood-borne Infections, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353, Berlin, Germany.
Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.
BMC Infect Dis. 2020 Feb 7;20(1):110. doi: 10.1186/s12879-020-4831-4.
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.
背景：男男性行为者（MSM）受到性传播感染（STI）的影响不成比例。STI 通常是外生殖器和无症状的。两者都可能延迟诊断和治疗。HIV 暴露前预防（PrEP）的批准可能会影响 HIV-MSM 的性行为和 STI 流行率。我们评估了德国 HIV-和 HIV+ MSM 的 STI 流行率和风险因素，以便计划有效的干预措施。
方法：我们在 2018 年 2 月至 7 月期间进行了一项全国性的横断面研究。13 家 MSM 友好型性传播感染诊所使用自我采集的直肠和咽部拭子和尿液样本，为 MSM 筛查沙眼衣原体（CT）、生殖支原体（MG）、淋病奈瑟菌（NG）和阴道毛滴虫（TV）。使用 APTIMA™性传播感染检测试剂盒（Hologic™ Inc.，美国圣地亚哥）进行诊断，样本不混合。我们收集了社会人口统计学、HIV 状况、临床症状、过去 6 个月内的性行为以及 PrEP 使用情况等信息。我们将 HIV 状况和 PrEP 使用情况结合起来，定义了风险组，并使用有向无环图和多变量逻辑回归来确定 STI 的风险因素。
结果：共纳入 2303 名 MSM：50.5%HIV+，中位年龄 39[18-79]岁。过去 6 个月内平均有 5 个性伴侣。73.6%的人没有使用安全套，44.6%的人使用派对药物。80.3%有性传播感染史，32.2%STI+ MSM 报告有 STI 相关症状。27.6%的 HIV- MSM 使用了 PrEP。总体 STI 流行率为 30.1%，HIV-/PrEP- MSM 为 25.0%（CT：7.2%；MG：14.2%；NG：7.4%；TV：0%），HIV-/PrEP+ MSM 为 40.3%（CT：13.8%；MG：19.4%；NG：14.8%；TV：0.4%），HIV+ MSM 为 30.8%（CT：10.1%；MG：18.4%；NG：8.6%；TV：0.1%）。HIV+（OR 1.7，95%-CI 1.3-2.2）、使用 PrEP（OR 2.0，95%-CI 1.5-2.7）、有>5 个性伴侣（OR：1.65；95%-CI：1.32-2.01.9）、无保护性行为（OR：2.11.9；95%-CI：1.65-2.86）和使用派对药物（OR：1.65；95%-CI：1.32-2.0）是至少一种 STI 检测呈阳性的独立危险因素。
结论：我们发现德国 MSM 的 STI 流行率很高，尤其是在 PrEP 使用者中，他们经常无症状。由于相当一部分 PrEP 使用者不会使用安全套，因此必须进行咨询和全面的性传播感染筛查，并且应该降低门槛，最好是免费的。还应该对 PrEP 使用者进行咨询，以解决使用派对药物的问题。
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