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O07 – BUGS, BEHAVIOUR AND BEYOND: NEW CHALLENGES FOR STI CONTROL AMONG GAY, BISEXUAL AND OTHER MEN WHO HAVE SEX WITH MEN
Monday, July 15, 2019 4:15 PM – 5:45 PM
O07.3 Sexually transmissible enteric infections in men who have sex with men: preliminary findings from a cross-sectional study
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  1. Holly Mitchell1,
  2. Gary Whitlock2,
  3. Jey Zdravkov2,
  4. Jenny Olsson3,
  5. Claire Jenkins4,
  6. Nicholas Thomson5,
  7. Nigel Field1,
  8. Gwenda Hughes4
  1. 1University College London, Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, London, UK
  2. 2Chelsea and Westminster Hospital NHS Foundation Trust, 56 Dean Street, London, UK
  3. 3Imperial College London, Imperial College School of Medicine, London, UK
  4. 4Public Health England, National Infection Service, London, UK
  5. 5Wellcome Trust Sanger Institute, Pathogen Genomics, Hinxton, UK

Abstract

Background Increasing rates of sexually transmissible enteric infections (STEIs) in men who have sex with men (MSM), often associated with antimicrobial resistance, are a growing public health concern. There is a need to better understand the characteristics and burden of STEIs to improve control measures.

Methods We conducted a cross-sectional study at a large London sexual health clinic (SHC) from December 2017 to February 2018. Residual rectal swabs collected from consecutive MSM attending for routine chlamydia/gonorrhoea testing (80% from asymptomatic screening), were anonymously tested for Shigella, Campylobacter, Salmonella and Escherichia coli by PCR. We generated STEI prevalence estimates and explored factors associated with STEIs using linked socio-demographic, behavioural and clinical data from electronic health records.

Results Of 2,138 specimens tested, overall STEI prevalence was 9.9% (95% CI: 8.6%-11.2%), ranging from 0.7% (95% CI: 0.4%-1.2%) for Shigella to 5.0% (95% CI: 4.1%-6.0%) for enteroaggregative E. coli. Salmonella was not detected. MSM with an STEI-positive specimen were more likely to be co-infected with gonorrhoea (23.7% vs 16.2%, p=0.006), to have a previous bacterial STI diagnosis (past year) (48.3% vs 37.4%, p<0.002), to report an ‘interest in high-risk sexual behaviours’ (e.g. Chemsex) (47.9% vs 38.7%, p=0.02), to report higher partner numbers (past 3 months) (median 6 vs 4, p<0.001), and among HIV-negative MSM, to report current use of HIV pre-exposure prophylaxis (PrEP) (54.7% vs 35.6%, p<0.001). Rectal or gastrointestinal symptoms were reported by 1.9% (39/2,098) of MSM, and this was not associated with overall STEI test result.

Conclusion Nearly one in ten MSM attending a London SHC had a rectal STEI detected. The association with higher-risk sexual behaviour and STIs strengthens the evidence that these pathogens are sexually transmitted. STEIs might be widely underdiagnosed in MSM and sub-clinical infection may support sustained transmission, suggesting the need for well-considered clinical and public health responses.

Disclosure No significant relationships.

  • gay bisexual and other men who have sex with men

https://doi.org/10.1136/sextrans-2019-sti.142

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