High Rates of Asymptomatic Infections With High Proportion of Genotypic Resistance to First-Line Macrolide Treatment Among Men Who Have Sex With Men Enrolled in the Zurich Primary HIV Infection Study.

BACKGROUND

() is an emerging sexually transmitted pathogen among men who have sex with men (MSM). Resistance to recommended antimicrobial agents are of public health concern. Few data exist on infections in MSM diagnosed with human immunodeficiency virus (HIV) during primary HIV infection.

METHODS

Participants of the Zurich Primary HIV Study (ClinicalTrials.gov Identifier NCT00537966) were systematically offered screening for sexually transmitted infections (STIs) between April 2019 and September 2020. Screening was performed using an in-house polymerase chain reaction panel comprising including genotypic resistance testing for macrolides and quinolones, including L1-L3, , , and .

RESULTS

We screened 148 of 266 (55.6%) participants, with an overall total of 415 follow-up visits. Ninety-one percent were MSM. The incidence rate for all STIs was 47.0 (95% confidence interval [CI], 32.2-68.6) per 100 person-years. was the most frequently detected pathogen: 30 participants (20%) presented with at least 1 infection, corresponding to a period prevalence of 20.3% and incidence rate of 19.5 infections (95% CI, 11.8-32.4). Most infections (93%) were asymptomatic, and 9 (30%) participants showed spontaneous clearance. We detected high rates of antibiotic resistance: 73.3% to macrolides, 3.3% to quinolones, and 13.3% resistance to both antibiotics.

CONCLUSIONS

The high prevalence of mostly asymptomatic infections and high rate of spontaneous clearance support cautious initiation for treatment. The high proportion of macrolide-resistant strains suggests that a genotypic determination of resistance should be standard of care. Moxifloxacin should be the preferred treatment option for symptomatic infections among MSM if resistance testing is unavailable.