Higher Sexually Transmissible Infection Test Yield Among Men Who Have Sex With Men Attending a Community-Based Testing Site Compared With a Clinical Service In Sydney, Australia.

ABSTRACT: From January 2014 to December 2015, the overall yield of sexually transmitted infections testing among asymptomatic MSM was two-fold higher at a community-based versus clinic-based service. Compared with the clinic-based service, yield of chlamydia (9.0% vs 4.9%; P = 0.010), gonorrhea (6.5% vs 3.1%; P < 0.001), and infectious syphilis (0.9% vs 0.1%; P = 0.024) were all higher at the community-based service.

Increases in pharyngeal Neisseria gonorrhoeae positivity in men who have sex with men, 2011-2015: observational study.

OBJECTIVES: Pharyngeal gonorrhoea disproportionately affects men who have sex with men (MSM). We explored temporal trends in pharyngeal gonorrhoea positivity among MSM compared with anorectal and urogenital positivity. METHODS: Data (2011-2015) were extracted from 41 publicly funded sexual health clinics participating in a national surveillance network. Positivity was defined as the proportion of first-visit testing occasions where gonorrhoea was detected. Logistic regression explored trends in positivity and correlates of positive pharyngeal tests. RESULTS: From 2011 to 2015, 24 792 MSM tested (16 710 pharyngeal, 19 810 urogenital and 15 974 anorectal first-visit tests). Pharyngeal positivity increased by 183% from 139/3509 (4.0%) in 2011 to 397/3509 (11.3%) in 2015, p-trend <0.001; urogenital positivity by 39% from 257/4615 (5.6%) to 295/3783 (7.8%), p-trend=0.006; and anorectal positivity by 87% from 160/3469 (4.6%) to 286/3334 (8.6%), p-trend <0.001. The annual temporal increase in positivity was greater in the pharynx (OR 1.33; 95% CI 1.27 to 1.38) than at urogenital (OR 1.06; 95% CI 1.02 to 1.10) and anorectal (OR 1.16; 95% CI 1.11 to 1.21) sites. Factors independently associated with pharyngeal gonorrhoea were: younger age (p<0.001), higher numbers of recent sexual partners (p-trend=0.004), contact with a person with a diagnosed STI (p<0.001), injecting drug use (p<0.001), anogenital symptoms (p<0.001) and HIV-positive status (p=0.050). CONCLUSION: Temporal increases in gonorrhoea positivity occurred at all anatomical sites, with the greatest increase in the pharynx. Risk factors could be used to help to develop testing and prevention strategies among MSM at highest risk. Strengthening sexual health service delivery, testing and surveillance remain priorities for pharyngeal gonorrhoea control.

Prevalence, incidence and predictors of anal Chlamydia trachomatis, anal Neisseria gonorrhoeae and syphilis among older gay and bisexual men in the longitudinal Study for the Prevention of Anal Cancer (SPANC).

OBJECTIVES: Sexually transmitted infection (STI) notifications are increasing among older individuals. Many older gay and bisexual men (GBM) are sexually active and have multiple partners. We aimed to investigate the prevalence, incidence and predictors of anal chlamydia, anal gonorrhoea and syphilis in older GBM. METHODS: The Study for the Prevention of Anal Cancer (SPANC) was a prospective cohort study of HPV infections and related anal lesions among community-recruited GBM age ≥ 35 years in Sydney, Australia. At baseline and subsequent annual visits, recent STI diagnoses were collected via questionnaire ('interval diagnoses') and STI testing occurred ('study visit diagnoses'). Baseline STI prevalence was calculated using study visit diagnoses. Incidence of anal chlamydia and gonorrhoea was calculated using interval and study visit diagnoses. Syphilis incidence was calculated using interval diagnoses. Univariate and multivariate analysis using Cox proportional hazards were undertaken to investigate the association between risk factors and incident STI. RESULTS: Among 617 GBM, the median age was 49 years (range 35-79) and 35.8% (n=221) were HIV-positive. At baseline, STI prevalence was: anal chlamydia 2.3% (n=14); anal gonorrhoea 0.5% (n=3) and syphilis 1.0% (n=6). During 1428 person-years of follow-up (PYFU), the incidence (per 100 PYFU) of anal chlamydia, anal gonorrhoea and syphilis was 10.40 (95% CI 8.82 to 12.25), 9.11 (95% CI 7.64 to 10.85) and 5.47 (95% CI 4.38 to 6.84), respectively. In multivariate analysis, HIV-positivity, higher number of recent condomless receptive anal intercourse partners and baseline methamphetamine use were associated with each STI. Sex with 'fuck-buddies' was associated with anal chlamydia and gonorrhoea. Age was not associated with any STI. DISCUSSION: There was a high incidence of STI among SPANC participants. Age should not be used as a proxy for sexual risk and older GBM require a detailed sexual behaviour and recreational drug use history. Interventions that specifically target STI risk among older GBM should be considered.

Increasing yield of pharyngeal Chlamydia trachomatis among male gay and bisexual clinic attendees in Sydney: an observational study.

Background The aim of the present study was to describe the temporal trends in Chlamydia trachomatis (CT) testing yield among gay and bisexual male (GBM) sexual health clinic attendees in Sydney. METHODS: All CT testing occasions among GBM from January 2011 to December 2014 were reviewed. Yield was defined as the proportion of testing occasions where CT was detected. RESULTS: In all, 2917 GBM were tested on 5445 occasions. CT was detected on 439 (8.1%; 95% confidence interval (CI) 7.4-8.8%) occasions. Pharyngeal, urethral and anorectal CT were detected on 74 (1.4%; 95% CI 1.1-1.7%), 109 (2.0%; 95% CI 1.7-2.4%) and 333 (6.1%; 95% CI 5.5-6.8%) occasions respectively. Over the study period, there was a significant increase in pharyngeal CT yield (from 0.70% to 1.6%; odds ratio (OR) 1.25; 95% CI 1.01-1.55; Ptrend=0.043), which remained borderline significant (OR 1.22; 95% CI 0.99-1.52; P=0.067) when adjusted for age. There was no change in yield of either urethral or anorectal infections. Almost half the pharyngeal CT (n=35; 47.3%) occurred without concurrent anogenital infection. Excluding those who would have received anti-chlamydial treatment for another reason, 27.0% of pharyngeal and 4.6% of all CT infections would not have been treated without pharyngeal testing. CONCLUSIONS: A recent temporal increase was observed in the yield of pharyngeal CT without a concurrent increase in anogenital yield. Ongoing surveillance is warranted to inform testing guidelines for GBM.