ABSTRACT
OBJECTIVES: Incidence of hepatitis B has not been well studied recently in men who have sex with men (MSM) despite increases in sexual risk practices and other sexually transmitted infections. Our aim was to determine the incidence of hepatitis B infection among MSM and level of immunity to hepatitis B attending a sexual health service over 10 years. METHODS: A cross-sectional analysis of all MSM attending Melbourne Sexual Health Centre (MSHC) from 1 July 2002 and 30 June 2012, and a retrospective cohort study of MSM who had attended MSHC on multiple occasions who had hepatitis serology done more than once. RESULTS: Of 10 031 MSM attending the clinic, 58.4% (95% CI 57.4% to 59.4%) (5655/9677) had hepatitis B surface antibody (HepBsAb), 10.6% (95% CI 10.0% to 11.4%) (840/7888) had core antibody (HepBcAb), and 3.7% (95% CI 3.0% to 4.5%) (95/2577) had surface antigen (HepBsAg). The proportion with HepBsAb decreased from 72% to 48% (p (trend)<0.001), with HepBcAb decreased from 12% to 8% (p (trend)=0.039) and with either HepBsAb or HepBcAb, decreased from 67% to 50% (p (trend)<0.001) from 2002 to 2012, but did not change for HepBsAg (p (trend)=0.08). Seven cases of hepatitis B occurred in 3540 person-years of observation, giving an incidence of 1.98 (95% CI 0.79 to 4.07) per 1000 person-years. CONCLUSIONS: The data suggest that the current level of immunity of about 50% has been sufficient to prevent any significant hepatitis B infection in the last 10 years. Continued high levels of vaccination are important for prevention.
Subject(s)
Hepatitis B Antibodies/analysis , Hepatitis B/immunology , Homosexuality, Male , Sexual Behavior/physiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Ambulatory Care Facilities , Australia/epidemiology , Cohort Studies , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay , Hepatitis B/blood , Hepatitis B/epidemiology , Hepatitis B virus/immunology , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Viral Hepatitis VaccinesABSTRACT
OBJECTIVE: High rates of syphilis have been reported among men who have sex with men (MSM) internationally. Guidelines recommend presumptive treatment of sexual contacts of individuals with syphilis at the point of care. The aim of this study was to determine the proportion who were infected with syphilis and the factors predictive of infection among men reporting contact with a man with syphilis. DESIGN: Contacts who were syphilis infected (cases) were compared with those who were uninfected (controls). SETTING: This study was conducted at the main public sexually transmitted diseases clinic in Victoria, Australia. PARTICIPANTS: One hundred and seventy-two MSM presenting as sexual contacts of men with syphilis at a sexual health service in Melbourne, Australia, between July 2007 and October 2011 were assessed for syphilis. OUTCOME MEASURES: Proportion of MSM who are infected with syphilis and factors associated with infection. RESULTS: Of the 172 men who presented reporting contact with syphilis, 26 (15%, 95% CI 10 to 20%) had syphilis. One man had primary syphilis, 4 had secondary syphilis, while the remaining 21 had early latent syphilis. Infection was associated with unprotected anal sex over the prior 3 months (adjusted OR 6.1, 95% CI 1.4 to 26.8). CONCLUSIONS: One in seven men presenting as contacts of syphilis had syphilis infection, most of whom were latently infected. Contacts reporting recent unprotected anal sex were more likely to have syphilis.
ABSTRACT
BACKGROUND: Epidemics of hepatitis A among men who have sex with men (MSM) have decreased significantly in recent years although the level of immunity that is required to prevent epidemics has not been studied. Our aim was to determine the level of immunity to hepatitis A among MSM. METHODS: This was a retrospective study conducted using notifications of Hepatitis A in Victoria from 1991 to 2010, serological testing for hepatitis A among MSM attending Melbourne Sexual Health Centre (MSHC), and vaccination records among MSM attending MSHC. RESULTS: Hepatitis A notifications declined from 370 to 47 and the male to female ratio declined from 4.2 to 0.9 in Victoria between 1991 to 2010. Between 2002 and 2011, there were 12,064 individuals MSM seen at MSHC of whom 3055 (25%) were tested for hepatitis A antibodies and 1180 (39%) had antibodies. The proportion of MSM who were tested for hepatitis A rose significantly over time (P<0.01), but the proportion of these with hepatitis A antibodies did not (P=0.28). Hepatitis A antibodies were more common in MSM over 30 (54%) compared to those 30 or less (32%), (Crude Odds Ratio 2.5 (95% confidence interval 2.1-2.9)) and were uncommon in MSM under 20 (19%). Vaccination against hepatitis A was recorded in 49% of 660 clinical files of MSM who attended the centre between 2003 and 2011 and did not change over time (P=0.42) but was significantly more common in those over 30 years of age (P<0.005). CONCLUSION: Hepatitis A is rare in MSM in Victoria where levels of immunity are about 40-50%. As outbreaks have occurred when levels of immunity were around 30%, maintaining vaccination levels over 40-50% is important if outbreaks are to be prevented. The lower levels of immunity in younger MSM create the potential for outbreaks in this sub-group.
