Introduction In England, men who have sex with men (MSM) who are HIV-positive are disproportionately affected by STIs, in part probably due to HIV sero-adaptive behaviours. Neisseria gonorrhoeae (NG) is of particular concern because treatment is threatened by antimicrobial resistance (AMR). In England, AMR NG has typically spread rapidly within sexual networks of MSM. We investigated whether the emergence and/or spread of AMR NG was associated with HIV-positive status.

Methods The prevalence of NG decreased susceptibility (DS) to ceftriaxone (MIC (mg/L)≥0.015), cefixime (≥0.125), and azithromycin AMR (≥1) from 2004–2015 was plotted by HIV status to investigate the emergence of DS/AMR using data from England and Wales collected within the Gonococcal Resistance to Antimicrobials Surveillance Programme. Differences were assessed using the Kolmogorov-Smirnov (KS) test. Logistic regression was used to model the association between HIV status and susceptibility to these antimicrobials in separate models adjusting for year.

Results Among all 5,630 MSM with NG, 25% of samples had DS/AMR to ceftriaxone, 8% to cefixime and 3% to azithromycin. A third (2024/5630) of MSM were HIV-positive. The distribution of prevalence of NG DS/AMR to ceftriaxone, cefixime and azithromycin was similar in HIV-positive and HIV-negative MSM across 2004–2015 (p>0.05 for each antimicrobial). In the logistic regression models, HIV-positive MSM were as likely as HIV-negative MSM to be infected with NG DS to ceftriaxone (DS/AMR prevalence in HIV-positive MSM vs HIV-negative MSM, adjusted odds ratio [95% confidence interval]) 25% vs 25%, 1.0 [0.9–1.1], cefixime 7% vs 8%, 1.1 [0.9–1.4] or azithromycin: 3% vs 3%, 0.9 [0.6–1.2].

Conclusion From these epidemiological data there is no evidence that MSM with HIV are at greater risk of DS/AMR NG compared to those without HIV. Whole genome sequencing will assist further investigations to explore relatedness of isolates and understand whether distinct populations of NG are spread more efficiently within sexual networks of HIV-positive MSM.