Article Text

Download PDFPDF
Sexual network characteristics and partnership types among men who have sex with men diagnosed with syphilis, gonorrhoea and/or chlamydia in Lima, Peru
  1. Jonathan Freese1,2,
  2. Eddy R Segura3,
  3. Jessica Gutierrez4,
  4. Jordan E Lake5,
  5. Robinson Cabello4,
  6. Jesse L Clark6,
  7. Cherie Blair6
  1. 1 University of Nebraska Medical Center, Omaha, Nebraska, USA
  2. 2 Department of Medicine, Division of Infectious Diseases, South American Program in HIV Prevention Research, Los Angeles, California, USA
  3. 3 Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
  4. 4 Asociación Civil Vía Libre, Lima, Peru
  5. 5 UTHealth Houston, Houston, Texas, USA
  6. 6 Department of Medicine, Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, USA
  1. Correspondence to Jonathan Freese, University of Nebraska Medical Center, Omaha, Nebraska, USA; jonathan.freese{at}


Objectives Sexual networks are known to structure sexually transmitted infection (STI) transmission among men who have sex with men (MSM). We sought to estimate the risks of STI diagnosis for various partnership types within these networks.

Methods Our cross-sectional survey analysed data from 1376 MSM screened for a partner management intervention in Lima, Peru. Participants were tested for HIV, syphilis, gonorrhoea (NG) and chlamydia (CT) and completed surveys on their demographics, sexual identity/role, HIV status, partnership types and sexual network from the prior 90 days. χ2 and Wilcoxon rank-sum tests compared participants without an STI to those diagnosed with (1) syphilis, (2) NG and/or CT (NG/CT) and (3) syphilis and NG/CT coinfection (coinfection).

Results 40.8% (n=561/1376) of participants were diagnosed with an STI (syphilis: 14.9%, NG/CT: 16.4%, coinfection: 9.5%). 47.9% of all participants were living with HIV and 8.9% were newly diagnosed. A greater proportion of participants with syphilis and coinfection were living with HIV (73.5%, p<0.001; 71.0%, p<0.001) compared with those with NG/CT (47.8%) or no STI (37.8%). Participants with syphilis more often reported sex-on-premises venues (SOPVs) as the location of their last sexual encounter (51.7%, p=0.038) while those with NG/CT tended to meet their last sexual partner online (72.8%, p=0.031). Respondents with coinfection were the only STI group more likely to report transactional sex than participants without an STI (31.3%, p=0.039).

Conclusions Sexual networks and partnership types of Peruvian MSM are associated with differential risks for STIs. Participants diagnosed with syphilis tended to meet single-encounter casual partners at SOPV, while MSM with NG/CT were younger and often contacted casual partners online. Coinfection had higher frequency of transactional sex. These findings suggest the potential importance of public health interventions through combined syphilis/HIV screening at SOPV, syphilis screening at routine clinic appointments for MSM living with HIV and directed advertisements and/or access to NG/CT testing through online platforms.

  • Disease Transmission, Infectious
  • Gonorrhea
  • Homosexuality, Male
  • Chlamydia Infections

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

View Full Text


  • Handling editor Kevin Martin

  • Twitter @Jessica Carol Gutierrez Lazaro

  • Contributors All authors contributed to critical review of this analysis. Additionally, JG contributed to study planning, coordination and acquisition of data. RC contributed to study planning, coordination, acquisition of data and review of results from analysis. ES contributed significantly to data cleaning, statistical analysis and interpretation of data. JLC, CB and JEL contributed to study coordination, statistical analysis, interpretation of data and manuscript development. JF, the guarantor, was the submitting author and contributed during each phase of development.

  • Funding We received funding from the following sources: University of California, Los Angeles’ South American Program in HIV Prevention Research (SAPHIR) (PI: Jesse Clark) (R25MH087222). Expedited Partner Therapy and the HIV Prevention Cascade Among MSM in Peru (PI: Jesse Clark) (R01MH118973). Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles (PI: Steve Shoptaw) (P30MH58107).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.