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New Human Immunodeficiency Virus Diagnosis Independently Associated With Rectal Gonorrhea and Chlamydia in Men Who Have Sex With Men

imageBackground: Rectal sexually transmitted infections (STI) have been associated with human immunodeficiency virus (HIV) diagnosis, but inferring a causal association requires disentangling them from receptive anal intercourse (RAI). Methods: We conducted a stratified case-control study by frequency matching 4 controls to each case within year using clinical data from men who have sex with men (MSM) attending the Seattle STD Clinic 2001 to 2014. Cases were MSM with a new HIV diagnosis and negative HIV test at 12 months or less. Controls were HIV-negative MSM. All included men had rectal STI testing, tested negative for syphilis, and had complete sexual behavior data. We categorized men by RAI: (1) none; (2) condoms for all RAI; (3) condomless RAI only with HIV-negative partners; and (4) condomless RAI with HIV-positive or unknown-status partners. We created 3 logistic regression models: (1) 3 univariate models of concurrent rectal gonorrhea, rectal chlamydia, and rectal STI in 12 months or less with new HIV diagnosis; (2) those 3 infections, plus age, race, year, number of sexual partners in 2 months or less, and methamphetamine use; and (3) model 2 with RAI categories. We calculated the population attributable risk of rectal STI on HIV diagnoses. Results: Among 176 cases and 704 controls, rectal gonorrhea, chlamydia and rectal STI in 12 months or less were associated with HIV diagnosis. The magnitude of these associations attenuated in the second model, but persisted in model 3 (gonorrhea: adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.3–3.8; chlamydia: aOR, 2.5; 95% CI, 1.5–4.3; prior STI: aOR, 3.0; 95% CI, 1.5–6.2). One in 7 HIV diagnoses can be attributed to rectal STI. Conclusions: Rectal STI are independently associated with HIV acquisition. These findings support the hypothesis that rectal STI play a biologically mediated causal role in HIV acquisition and support screening/treatment of STI for HIV prevention. 07/01/2017 01:00 AM

Is Patient-Reported Exposure a Reliable Indicator for Anogenital Gonorrhea and Chlamydia Screening in Young Black Men Who Have Sex With Men?

imageAbstract: Among 485 young black men who have sex with men recruited in Jackson, MS, 90-day anal sexual exposure significantly predicted rectal infection, but 19.4% of rectal infections would have been missed among men denying receptive anal sex. Reports of consistent condom use were associated with lower infection rates only in men reporting insertive anal sex. 07/01/2017 01:00 AM

Increases in the Rate of Neisseria gonorrhoeae Among Gay, Bisexual and Other Men Who Have Sex With Men—Findings From the Sexually Transmitted Disease Surveillance Network 2010–2015

imageBackground: Inequalities in Neisseria gonorrhoeae (gonorrhea) burden by sexual minority status in the United States are difficult to quantify. Sex of sex partner is not routinely collected for reported cases. Population estimates of men who have sex with men (MSM) necessary to calculate case rates have not been available until recently. For these reasons, trends in reported gonorrhea rates among MSM have not been described across multiple jurisdictions. Methods: We estimated of the number of MSM cases reported in 6 jurisdictions continuously participating in the STD Surveillance Network 2010–2015 based on interviews with a random sample of cases. Data were obtained for Baltimore, Philadelphia, New York City, San Francisco, California (excluding San Francisco), and Washington State. Estimates of the MSM, heterosexual male (MSW) and female populations were obtained from recently published estimates and census data. Case rates and rate-ratios were calculated comparing trends in reported cases among MSM, heterosexual males and women. Results: The proportion of male gonorrhea cases among MSM varied by jurisdiction (range: 20% to 98%). Estimated MSM rate increased from 1369 cases per 100,000 in 2010 to 3435 cases per 100,000 in 2015. Between 2010 and 2015, the MSM-to-Women gonorrhea rate ratio increased from 13:1 to 24:1, and the MSM-to-MSW gonorrhea rate ratio increased from 16:1 to 31:1. Conclusions: Estimated gonorrhea rate among MSM increased in a network of 6 geographically diverse US jurisdictions. Estimating the size of this population, determining MSM among reported cases and estimating rates are essential first steps for better understanding the changing epidemiology of gonorrhea. 07/01/2017 01:00 AM

Comparative Evaluation of 2 Nucleic Acid Amplification Tests for the Detection of Chlamydia trachomatis and Neisseria gonorrhoeae at Extragenital Sites

imageAbstract: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are frequently asymptomatic, requiring highly accurate diagnostic tests and proper management to prevent further transmission. We compared two nucleic acid tests, Xpert® CT/NG (Cepheid, Sunnyvale, CA) point-of-care platform and at an offsite clinical laboratory with Aptima Combo 2® (Hologic, Inc., San Diego, CA) assay, for the detection of extragenital infection in patients at an STI clinic in Hollywood, CA. We calculated concordance between the two assays and used the exact binomial method to calculate 95% confidence intervals (CIs) for each specimen type and pathogen. The concordance between the two assays was 97.7% (95% CI: 95.7%,99.0%) for 393 paired CT rectal results, 98.2% (95% CI: 96.4%,99.3%) for 391 paired NG rectal results and 98.4% (95% CI: 96.8%,99.4%) for 448 paired NG pharyngeal results. The performance of Xpert® CT/NG assay in point-of-care testing in extragenital specimens was highly similar to the laboratory-based platform. 07/01/2017 01:00 AM

Portrait of an Epidemic: Extremely High Human Immunodeficiency Virus Prevalence and Incidence Among Young Black Men Having Sex With Men and Residing in a Southern City

Abstract: A 12-month prospective cohort study of 609 young black men who have sex with men (YBMSM) assessed human immunodeficiency virus seroconversion. One-hundred-seventy men (27.9%) were either human immunodeficiency virus–infected before enrollment or tested positive within 30 days afterward. Thirty (4.9%) were classified as incident infections occurring in a 12-month period. Subtracting the 170 from the denominator, incidence was 6.8%. 07/01/2017 01:00 AM

Azithromycin Efficacy in Asymptomatic Rectal Chlamydial Infection in Men Who Have Sex With Men: A More Definitive Answer Soon?

No abstract available 07/01/2017 01:00 AM

Playing and Never Testing: Human Immunodeficiency Virus and Sexually Transmitted Infection Testing Among App-Using MSM in Southeast Asia

imageAbstract: Little is known about mobile application (app)-based behavior of men who have sex with men (MSM) in Thailand. A cross-sectional online assessment of app users in Bangkok found that more than a quarter have never tested for human immunodeficiency virus (HIV) and 1 in 3 never tested for sexually transmitted infections (STI). STI testing patterns and HIV testing frequency were highly associated with each other in multinomial logistic regression. In the midst of an escalating epidemic where HIV incidence among MSM is highest in Asia, apps can serve to engage those least likely to be reached by traditional methods of recruitment and outreach in Thailand. 07/01/2017 01:00 AM

Laboratory Evaluation of a Smartphone-Based Electronic Reader of Rapid Dual Point-of-Care Tests for Antibodies to Human Immunodeficiency Virus and Treponema pallidum Infections

imageBackground: Dual point-of-care tests for antibodies to human immunodeficiency virus (HIV) and Treponema pallidum allow for same-day testing and treatment and have been demonstrated to be cost-effective in preventing the adverse outcomes of HIV infection and syphilis. By recording and transmitting data as they are collected, electronic readers address challenges related to the decentralization of point-of-care testing. Methods: We evaluated a smartphone-based electronic reader using 201 sera tested with 2 dual rapid tests for detection of antibodies to HIV and T. pallidum in Los Angeles, USA, and Lima, Peru. Tests were read both visually and with the electronic reader. Enzyme immunoassay followed by Western blot and T. pallidum particle agglutination were the reference tests for HIV and T. pallidum, respectively. Results: The sensitivities of the 2 rapid tests for detection of HIV were 94.1% and 97.0% for electronic readings. Both tests had a specificity of 100% for detection of HIV by electronic reading. The sensitivities of the 2 rapid tests for detection of T. pallidum were 86.5% and 92.4% for electronic readings. The specificities for detection of T. pallidum were 99.1% and 99.0% by electronic reading. There were no significant differences between the accuracies of visual and electronic readings, and the performance did not differ between the 2 study sites. Conclusions: Our results show the electronic reader to be a promising option for increasing the use of point-of-care testing programs. 07/01/2017 01:00 AM