Background: Ano-genital warts (AGW) in men who have sex with men (MSM) are common and may be a risk factor for HIV acquisition. We explored the feasibility of measuring external AGW prevalence, and reported condom use for anal sex to identify risk for HIV acquisition among MSM in Lima, Peru.
Methods: 600 MSM (300 with AGW) were recruited from a community-based setting in Lima, Peru in a prospective cohort study to examine the effect of AGW on incident HIV infection. Participants completed a self-administered questionnaire on sexual behaviour, and underwent physical examination. Logistic regression was used to assess the association between sexual behavior and AGW.
Results: The median age of study participants was 24 years, with 83.8% reporting sex exclusively with men, and 47.9% self-identifying as gay. During the past three months, 70% of participants had at least one episode of anal sex without a condom, and nearly half reported current STI symptoms (41.2%) including burning while urinating, penile lesions, genital warts, and anal lesions. Upon physical exam, the majority of AGW were limited to anal only (60%). A first experience of anal sex at age 19 years or older (OR=2.9, 95%CI 1.5-5.6) and self-reporting of current STI symptoms (OR=3.4, 95%CI 2.2-5.1) were significant predictors of prevalent AGW. A self-reported receptive role during anal sex (OR=0.55, 95%CI 0.35-0.89) was protective against AGW. An upwards trend for increased AGW risk was identified with an increasing number of episodes of unprotected anal sex, albeit not significantly (p=0.4).
Conclusions: Prevalence of AGW was associated with later age at first anal sex, and STI symptoms. Further research should examine the role of receptive anal sex in protection against AGW, with a larger sample size. Objective tools to measure HIV-risk behaviors are needed, and STI co-infection including HPV related manifestations may be a good proxy.