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Serosorting and recreational drug use are risk factors for diagnosis of genital infection with chlamydia and gonorrhoea among HIV-positive men who have sex with men: results from a clinical cohort in Ontario, Canada
  1. Ramandip Grewal1,
  2. Vanessa G Allen2,
  3. Sandra Gardner3,4,
  4. Veronika Moravan5,
  5. Darrell H S Tan6,7,8,
  6. Janet Raboud3,7,
  7. Ahmed M Bayoumi1,6,7,8,
  8. Rupert Kaul6,
  9. Tony Mazzulli2,11,
  10. Frank McGee12,
  11. Sean B Rourke1,5,13,
  12. Ann N Burchell1,3,14
  13. in collaboration with the OHTN Cohort Study Research Team
    1. 1Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
    2. 2Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada
    3. 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
    4. 4Baycrest Health Science, Toronto, Ontario, Canada
    5. 5Ontario HIV Treatment Network, Toronto, Ontario, Canada
    6. 6Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    7. 7Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
    8. 8Division of Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada
    9. 9Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    10. 10Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
    11. 11Department of Microbiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
    12. 12AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada
    13. 13Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
    14. 14Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
    1. Correspondence to Dr Ann N Burchell, Department of Family and Community Medicine and Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8; burchella{at}


    Objectives Rates of chlamydia and gonorrhoea have been rising in urban centres in Canada, particularly among HIV-positive men who have sex with men (MSM). Our objective was to identify behavioural risk factors for diagnosis with chlamydia and gonorrhoea in this population, with a focus on the HIV status of sexual partners.

    Methods The OHTN Cohort Study follows people in HIV care across Ontario. We restricted the analysis to 1997 MSM who completed questionnaires in 2010–2013 at one of seven clinics that submit all chlamydia and gonorrhoea tests to the provincial public health laboratory; we obtained test results via record linkage. We estimated cumulative incidences using Kaplan–Meier methods and identified risk factors for diagnosis of a composite outcome (chlamydia or gonorrhoea infection) using Cox regression.

    Results At follow-up, there were 74 new chlamydia/gonorrhoea diagnoses with a 12-month cumulative incidence of 1.7% (95% CI 1.1% to 2.2%). Risk factors for chlamydia/gonorrhoea diagnosis were: 5+ HIV-positive partners (HR=3.3, 95% CI 1.4 to 7.8; reference=none) and recreational drug use (HR=2.2, 95% CI 1.2 to 3.9).

    Conclusions Heightened risks with recreational drug use and multiple HIV-positive partners suggest that chlamydia/gonorrhoea may have achieved high prevalence in certain sexual networks among HIV-positive MSM. Interventions to promote safer sex and timely testing among MSM are needed.

    • GAY MEN
    • HIV

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    • Handling editor Jackie A Cassell

    • Collaborators The OHTN Cohort Study Team consists of Dr SBR (Principal Investigator), University of Toronto and OHTN; Dr Sergio Rueda, CAMH; Dr ANB, Dr AMB, Dr Kevin Gough and Dr DHST, St Michael’s Hospital; Dr Jeffrey Cohen, Windsor Regional Hospital; Dr Curtis Cooper, Ottawa General Hospital; Dr Don Kilby, University of Ottawa Health Services; Dr Mona Loutfy and Dr Fred Crouzat, Maple Leaf Medical Clinic; Dr Anita Rachlis and Dr Nicole Mittmann, Sunnybrook Health Sciences Centre; Dr JR and Dr Irving Salit, Toronto General Hospital; Dr Edward Ralph, Dr Michael Silverman, St Joseph’s Health Care; Dr Roger Sandre, Sudbury Regional Hospital; and Dr Gerald Evans and Dr Wendy Wobeser, Hotel Dieu Hospital.

    • Contributors RG conducted the analysis and wrote the manuscript. ANB was the principal investigator who conceived the project, obtained funding and contributed to the direction of the analysis and manuscript writing; she is the guarantor. ANB and SBR directed data collection at clinic sites. VGA and TM directed laboratory analysis at the PHOL and its interpretation. SG, VM and JR provided statistical expertise. AMB, RK, DHST and FM, contributed to the study protocol and guided interpretation. All authors provided critical input into the analysis, read an earlier version of the paper, provided substantive feedback and approved the final paper.

    • Funding This work was supported by Canadian Institutes of Health Research (CIHR) operating grant 111146, CIHR New Investigator awards to ANB and to DHST, an OHTN Chair and support from the Toronto and Western Hospital Foundation Skate the Dream Fund for JR and a Fondation Baxter and Alma Ricard Chair in Inner City Health at St Michael's Hospital for AMB. The OHTN Cohort Study is funded by the AIDS Bureau, Ontario Ministry of Health and Long-Term Care.

    • Disclaimer The opinions, results and conclusions are those of the authors and no endorsement by the Ontario HIV Treatment Network or Public Health Ontario is intended or should be inferred.

    • Competing interests None declared.

    • Ethics approval University of Toronto HIV Research Ethics Board (protocol reference 23954).

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

    • Data sharing statement The OHTN may authorise the collection, use and disclosure of OCS data for the purpose of scholarly research if the proposal for the research project has been reviewed and approved and the research project principal investigator and all other members of the research project team have signed a researcher's agreement with the OHTN and adhere to all relevant OCS data and research policies.

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