Objectives Rectal infections with Chlamydia trachomatis and/or Neisseria gonorrhoeae (CT/NG) are common in men who have sex with men (MSM) and are linked to HIV transmission. However, rectal CT/NG infections are often asymptomatic and it is not known how they contribute to HIV transmission. We assessed clinical and cytological signs of inflammation as well as rectal HIV-RNA in HIV-infected MSM with and without CT/NG infection.
Methods 112 HIV-positive MSM with or without rectal symptoms and with or without antiretroviral therapy who underwent high-resolution anoscopy (HRA) at the proctological outpatient centre of the University Hospital Essen, Germany, between November 2013 and February 2014 were included in this cross-sectional study. During the examination, rectal swabs for the assessment of CT/NG, HIV-RNA and inflammatory cells (granulocytes, lymphocytes, histiocytes) were collected. 110 patients were assessed according to the study protocol, and no imputation of missing data was performed.
Results Rectal infections with CT or NG were detected in 17 participants, and 4 participants were coinfected. Only symptomatic CT/NG infections (8/17) showed signs of inflammation in HRA. Symptomatic CT/NG infections were also associated with the detection of lymphocytes and histiocytes in rectal cytology (both P<0.001). In contrast, asymptomatic CT/NG infections neither resulted in clinical nor cytological signs of inflammation. Rectal HIV-RNA was undetectable in all participants with rectal CT/NG infections who received combined antiretroviral therapy (ART) when plasma HIV-RNA was below the limit of detection (n=13). Besides rectal CT/NG infections, syphilis (n=4) and HPV-associated lesions (n=37) were frequently detected, and proctological symptoms were associated with simultaneous infection with ≥2 STDs.
Conclusions Only symptomatic but not asymptomatic rectal infections with CT and/or NG were associated with clinical and cytological signs of inflammation. Rectal HIV shedding was not promoted by CT/NG infections in patients receiving ART with suppressed plasma HIV-RNA.
Trial registration number UTN: U1111-1150-4804. German Clinical Trials Register (DRKS): DRKS00005468.
- neisseria gonorrhoea
- chlamydia trachomatis
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Handling editor Gary Brook
Contributors JS designed the study, performed HRA, collected samples, contributed to the establishment of the method for detection of rectal HIV-RNA, contributed to the interpretation of the data, and prepared and revised the manuscript. JV contributed to the establishment of the method for detection of rectal HIV-RNA and performed HIV-RNA detection. EW prepared the data set. JW established and performed inflammatory cell analysis in rectal cytology. EHvH performed CT/NG testing. DS gave important intellectual input to study design and to the manuscript. SE designed the study, performed HRA, collected samples, contributed to the interpretation of the data and revised the manuscript critically for important intellectual content. All authors have read and commented on the manuscript, and all authors saw and approved the final version of the manuscript. All authors agreed to be accountable for all aspects of the work.
Funding This study was in part funded by the German Federal Ministry of Health (BMG) (no: 686 18; year: 2013).
Competing interests JS reports grants from the German Federal Ministry of Health (BMG), during the conduct of the study; employee of Janssen Cilag, September 2014 until September 2017, and employee of Novartis Pharma AG since October 2017, outside the submitted work. JV reports personal fees from Abbott, personal fees from Roche, grants and personal fees from Janssen, personal fees from Siemens and personal fees from BMS, outside the submitted work. DS reports personal fees from Amgen, GSK, BMS, Novartis, Roche, Amgen, Merck, AstraZeneca, Merck Serono and Pfizer, outside the submitted work. SE reports personal fees from Gilead, personal fees from MSD, personal fees from Janssen, personal fees from ViiV, personal fees from AbbVie, grants from Gilead, grants from ViiV, grants from MSD and grants from Janssen, outside the submitted work.
Patient consent Obtained.
Ethics approval The study was approved by the ethics committee of the medical department of the University of Duisburg-Essen (13-5650-BO).
Provenance and peer review Not commissioned; externally peer reviewed.
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