Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America.
Institute of Human Virology Nigeria, Abuja, Nigeria.
PLoS One. 2020 Sep 4;15(9):e0238745. doi: 10.1371/journal.pone.0238745. eCollection 2020.
Men who have sex with men (MSM) and transgender women (TGW) are at risk for sexually transmitted infections (STIs), including those of the oropharynx. We estimated the prevalence and factors associated with oral sex practices and characterized oropharyngeal STIs among a cohort of MSM and TGW in Nigeria.
From 2013 to 2018, TRUST/RV368 recruited MSM and TGW into HIV/STI diagnosis and treatment at community-based clinics in Nigeria. Participants who completed HIV testing and oral sex questions at enrollment were selected. Cross-sectional analyses with bivariate and multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs). Oropharyngeal swab testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) began in 2014 and for those with diagnostic results at enrollment, the unadjusted association of oral sex practices with oropharyngeal STIs was conducted.
A total of 1342 participants had a median age of 25 years (interquartile range: 22-29), 58% were living with HIV, and 69% reported oral sex practices. Factors associated with increased odds of engaging in oral sex included living with HIV (adjusted [a]OR: 1.4, 95% CI: 1.1-1.8), self-identifying as a woman (aOR:1.8, 95% CI: 1.1-2.8), mobile phone ownership (aOR:2.3, 95% CI: 1.3-3.9), receptive anal sex (aOR:1.7, 95% CI:1.3-2.3) and multiple male sexual partners (2 to 4 vs. ≤1, aOR:1.5, 95% CI: 1.0-2.2; 5+ vs ≤1, aOR:2.9, 95% CI:1.9-4.3). Oropharyngeal STI prevalence was 7% (52/752) and higher among those who engaged in oral sex compared to those who did not (unadjusted OR: 2.5, 95% CI:1.2-5.3).
Oral sex was common and associated with an increased odds of oropharyngeal STIs among MSM and TGW from Nigeria. In the absence of screening and treatment guidelines, condoms continue to be the mainstay for oral STI prevention. A pre-exposure prophylaxis for bacterial STIs would complement current prevention strategies to curb transmission.
男男性行为者（MSM）和跨性别女性（TGW）面临性传播感染（STI）的风险，包括口咽部感染。我们评估了尼日利亚一个 MSM 和 TGW 队列中与口交行为相关的流行率和相关因素，并对口咽部 STI 进行了特征描述。
2013 年至 2018 年，TRUST/RV368 在尼日利亚的社区诊所招募 MSM 和 TGW 进行 HIV/STI 诊断和治疗。选择了在入组时完成 HIV 检测和口交问题的参与者。采用横断面分析，使用双变量和多变量逻辑回归模型估计比值比（OR）和 95%置信区间（CI）。2014 年开始对淋病奈瑟菌（NG）和沙眼衣原体（CT）进行咽拭子检测，对于入组时已有诊断结果的患者，进行了未调整的口交行为与口咽部 STI 之间的关联分析。
共有 1342 名参与者的中位年龄为 25 岁（四分位距：22-29），58%的人 HIV 阳性，69%的人有口交行为。与增加口交可能性相关的因素包括 HIV 阳性（调整后的[ a]OR：1.4，95%CI：1.1-1.8）、自我认同为女性（aOR：1.8，95%CI：1.1-2.8）、拥有移动电话（aOR：2.3，95%CI：1.3-3.9）、接受肛交（aOR：1.7，95%CI：1.3-2.3）和多个男性性伴侣（2-4 个与≤1 个，aOR：1.5，95%CI：1.0-2.2；5 个及以上与≤1 个，aOR：2.9，95%CI：1.9-4.3）。咽拭子检测发现口咽部 STI 的患病率为 7%（52/752），与无口交行为者相比，有口交行为者的患病率更高（未调整的 OR：2.5，95%CI：1.2-5.3）。
在尼日利亚的 MSM 和 TGW 中，口交行为很常见，且与口咽部 STI 的发生风险增加相关。在没有筛查和治疗指南的情况下，安全套仍然是预防口腔 STI 的主要方法。针对细菌 STI 的暴露前预防将是目前预防策略的补充，以遏制传播。
