Prevalence of infection with antimicrobial resistance mutations among gay sex workers in China.

BACKGROUND

Gay sex workers (GSWs) within the population of men who have sex with men in China are known as money boys (MBs). Limited research has been conducted to investigate the infection rate and antimicrobial resistance of () among GSWs in China. This study aimed to evaluate the status of infection among in GSWs.

METHODS

This study was performed among 349 GSWs who were followed up for four years by internet-based sampling collection. The participants were asked to complete an online questionnaire using a mobile app, and trained interviewers took urethral, anorectal, and saliva swab specimens. STIs, including HIV and , were detected. Detection of resistance-associated mutations (RAMs) to macrolides and fluoroquinolones was performed via Sanger sequencing of the 23S rRNA, and genes.

RESULTS

GSWs were enrolled by identifying 10 initial "seeds" from the Blued and WeChat apps. Face-to-face interviews were conducted with 349 GSWs from June 2017 to July 2021. The prevalence of and HIV positivity was 92/349 (26.4%, 95% confidence interval [CI] 21.7-31.0) and 71/349 (20.3%, 95% CI 16.3-24.4), respectively. The proportion of GSWs with infection alone in urethral swabs was 16, and the proportion with symptoms was 2/16 (12.5%). The proportion of GSWs with infection alone in anorectal swabs was 36, and the proportion with symptoms was 3/36 (8.3%). Multivariate regression analysis showed that using new types of drugs in the past 3 months and inconsistent condom usage with clients in the past 30 days were associated with infection. Macrolide resistance within the 23S rRNA gene was detected in 73/88 (83.0%) of the -positive GSWs. Moreover, 79.8% (71/89) of and 21.1% (19/90) of genes had mutations responsible for fluoroquinolone resistance. Three cases had no mutations in any of the three genes, 11 cases had mutations in all three genes, five cases had and gene mutations with no mutation in the 23S rRNA gene, and 42 cases had 23S rRNA and gene mutations with no mutation in the gene.

CONCLUSION

infections in our study displayed a high prevalence and very high levels of macrolide and fluoroquinolone resistance among GSWs in China. Asymptomatic infections are quite common among GSWs. Routine resistance testing of -positive specimens and antimicrobial resistance surveillance are crucial.