Service de Biologie Clinique, Hôpital Foch, Suresnes, France.
Centre de Vaccinations Internationales et Médecine de Voyage, Creil, France.
PLoS One. 2021 Jun 24;16(6):e0250557. doi: 10.1371/journal.pone.0250557. eCollection 2021.
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.
性传播感染（STI）在感染 HIV 的男男性行为者（MSM）中负担尤其沉重。最近，美国和西欧国家注意到 STI 的流行率有所上升。我们旨在评估 STI 筛查建议公布后无症状 STI 的趋势，即衣原体（CT）和淋病（NG）。位于巴黎地区的 17 个中心参与了这项研究。所有接受随访咨询的无症状 HIV 感染 MSM 患者都被提议参与这项研究。无症状患者分两个阶段纳入：第一阶段为 2015 年 4 月至 12 月，第二阶段为 2017 年 9 月至 12 月。使用血清学检测，包括梅毒的非梅毒螺旋体滴度和确认梅毒螺旋体检测，对乙型肝炎、丙型肝炎和梅毒的病因进行诊断。CT 和 NG 使用三种解剖部位的核酸扩增检测（NAATs）进行筛查，即尿液、直肠和咽部。共有 781 名患者被纳入：第 1 阶段 490 名，第 2 阶段 291 名。无症状 CT、NG 和梅毒的诊断率分别为 7.5%、4.8%和 4.2%。多部位无症状感染的患者比例分别为 CT 和 NG 的 10.2%和 21.1%。CT 和 NG 无症状感染最常涉及的解剖部位分别为肛直肠（66.1%和 55.2%）和咽部（47.4%和 60.5%）。CT 和 NG 无症状感染在两个时期分别增加了 1.3 倍和 2 倍，而梅毒则减少了 3 倍。我们的研究结果鼓励重新考虑对无症状 HIV 阳性 MSM 进行多部位 CT 和 NG 筛查，因为仅对尿液样本进行筛查的效果可能较低。尽管对无症状 HIV 阳性 MSM 进行了更系统的 STI 筛查，但法国 MSM 中的 STI 流行率仍在上升。因此，这种策略并未改变 CT 和 NG 的传播。梅毒的减少可能涉及到自行使用多西环素治疗，以及加强梅毒筛查。
