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Prevalence and characteristics of gastrointestinal infections in men who have sex with men diagnosed with rectal chlamydia infection in the UK: an ‘unlinked anonymous’ cross-sectional study
  1. Gwenda Hughes1,
  2. Panida Silalang2,
  3. John Were1,
  4. Hemanti Patel3,
  5. Tristan Childs2,
  6. Sarah Alexander3,
  7. Stephen Duffell1,
  8. Cara Saxon4,
  9. Cathy Ison3,
  10. Holly Mitchell1,5,
  11. Nigel Field1,5,
  12. Claire Jenkins2
  1. 1Department of HIV and STI, National Infection Service, Public Health England, London, UK
  2. 2Gastrointestinal Infection Reference Service, Microbiology Services Centre, National Infection Service, Public Health England, London, UK
  3. 3Sexually Transmitted Infection Reference Service, Microbiology Services Centre, National Infection Service, Public Health England, London, UK
  4. 4Department of Sexual Medicine and HIV, University Hospitals of South Manchester NHS Foundation Trust, Manchester, UK
  5. 5Research Department of Infection and Population Health, University College London, London, UK
  1. Correspondence to Dr Gwenda Hughes, Department of HIV and STI, National Infection Service, Public Health England, Colindale, London NW9 5EQ, UK; Gwenda.hughes{at}phe.gov.uk

Abstract

Introduction Gastrointestinal infections (GII) can cause serious ill health and morbidity. Although primarily transmitted through faecal contamination of food or water, transmission through sexual activity is well described, especially among men who have sex with men (MSM).

Methods We investigated the prevalence of GIIs among a convenience sample of MSM who were consecutively diagnosed with rectal Chlamydia trachomatis (CT) at 12 UK genitourinary medicine clinics during 10 weeks in 2012. Residual rectal swabs were coded, anonymised and tested for Shigella, Campylobacter, Salmonella, shiga toxin-producing Escherichia coli and enteroaggregative E. coli (EAEC) using a real-time PCR. Results were linked to respective coded and anonymised clinical and demographic data. Associations were investigated using Fisher's exact tests.

Results Of 444 specimens tested, overall GII prevalence was 8.6% (95% CI 6.3% to 11.6%): 1.8% (0.9% to 3.6%) tested positive for Shigella, 1.8% (0.9% to 3.6%) for Campylobacter and 5.2% (3.5% to 7.7%) for EAEC. No specimens tested positive for Salmonella or other diarrhoeagenic E. coli pathotypes. Among those with any GII, 14/30 were asymptomatic (2/7 with Shigella, 3/6 with Campylobacter and 9/17 with EAEC). Shigella prevalence was higher in MSM who were HIV-positive (4.7% (2.1% to 10.2%) vs 0.5%(0.1% to 3.2%) in HIV-negative MSM; p=0.01).

Conclusions In this small feasibility study, MSM with rectal CT appeared to be at appreciable risk of GII. Asymptomatic carriage may play a role in sexual transmission of GII.

  • GASTROINTESTINAL
  • INFECTION
  • GAY MEN
  • EPIDEMIOLOGY (GENERAL)
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Footnotes

  • Correction notice This article has been edited since it first published Online First. Typing errors have been removed.

  • Handling editor Jackie A Cassell

  • Twitter Follow Sarah Alexander @sarah1alexander and Nigel Field @fienige

  • Contributors GH, CJ, NF and CI devised the study and developed the protocol. PS, HP and SA processed laboratory specimens and undertook all testing, overseen by CJ and CI. JW, TC, CS, SD and GH developed and undertook the data anonymisation and linkage protocol, and JW and GH performed the data analysis. GH wrote the first draft of the manuscript. All authors read the manuscript and provided comments.

  • Funding Undertaken as part of PHE-funded public health surveillance.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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