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Be A Hero Vaccine Preparedness Study |
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Incidence of HIV and sexually transmitted diseases (STD) in a cohort of HIV-negative men who have sex with men (MSM).
Source:
AIDS 1998 Oct 22;12(15):2041-8
Authors:
Tabet SR, Krone MR, Paradise MA, Corey L, Stamm WE, Celum CL.
Publication Info:
Department of Medicine, School of Medicine, University of Washington, Seattle, USA.
Abstract:
OBJECTIVE: To determine the prevalence of sexually transmitted diseases (STD) and
incidence of and risk factors for STD, including HIV-1, among a cohort of
HIV-negative men who have sex with men (MSM). SETTING: Seattle, Washington, United
States. PARTICIPANTS: Prospective cohort of 578 HIV-negative MSM in which risk
factors for acquiring a STD over 12 months follow-up were evaluated using a
cumulative incidence analysis. MAIN OUTCOME MEASURES: Baseline tests obtained were:
herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) Western blots, hepatitis B, and
syphilis serologies; anorectal and pharyngeal Neisseria gonorrhoeae (GC) cultures;
first-catch urine for leukocyte esterase (LE) and Chlamydia trachomatis (CT) ligase
chain reaction (LCR). Men with a positive urine LE had urethral GC cultures
obtained. The following outcomes were measured over 12 months follow-up: incident
symptomatic bacterial STD (urethritis, proctitis, epididymitis), HSV-1 and HSV-2
seroconversion, and HIV-1 seroconversion. The 31 incident cases of STD (men with
bacterial STD) were compared with those 489 men without symptomatic bacterial STD or
seroconversion to HSV-1, HSV-2 or HIV-1 infection. RESULTS: Bacterial STD were found
in nine participants at enrollment; there were two cases of nonchlamydial
urethritis, two cases of nonchlamydial epididymitis, and five cases of asymptomatic
GC infection. At enrollment, HSV-2 antibodies were detected in 149 (26.0%) of 572
men and prior hepatitis B infection in 145 (34.8%) of 417 unvaccinated men. During
the 1-year of follow-up, 31 men (5.7/100 person-years) had 34 episodes of a
symptomatic bacterial STD syndrome (urethritis, epididymitis or proctitis).
Urethritis was the most common STD syndrome, detected in 29 men, of whom 10 had GC
and 19 had nongonococcal urethritis. In the 1-year of follow-up, five participants
seroconverted to HIV-1 (1.3/100 person-years), four to HSV-2 (1.0/100 person-years),
and seven to HSV-1 (4.3/100 person-years). Unprotected insertive anal sex [odds
ratio (OR) 2.6; 95% confidence interval (CI) 1.2-5.6]; and nitrite inhalant
('poppers') use (OR, 2.3; 95% CI, 1.0-5.0) were independently associated with
incident STD. CONCLUSIONS: STD and HIV infection continue to be acquired even in a
city with an overall low bacterial STD prevalence and among educated MSM receiving
regular HIV screening and risk-reduction. Urethritis was the most common STD
detected, and public health messages aimed at MSM need to emphasize safe insertive
as well as receptive sexual practices.
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