High Prevalence of Rectal and Penile Coital Injury Among Men Who Have Sex with Men (MSM) at a U.S. Public Health Department Sexually Transmitted Infection Clinic: Associations with STIs and Behavior

Background: Rectal coital injury (RCI) is associated with HIV risk among men who have sex with men (MSM), but there are few studies of penile coital injury (PCI). We described the prevalence of RCIs and PCIs and associated factors among an urban MSM population.

Methods: We conducted a cross-sectional study of 87 MSM, aged 16-35, accessing care at a public STI clinic in Chicago between 10/2014-7/2015. Personal interview assessed RCI or PCI in the past 6 months by three questions: rectal/penile soreness; rectal/penile scratches-abrasions; rectal/penile bleeding. RCI and PCI outcomes were each defined as “none”, “soreness only”, or “scratches and/or bleeding”. Clinical and laboratory data were abstracted from charts. We present adjusted prevalence rate ratios (aPRR) from multivariable multinomial logistic regression.

Results: Men were median age 26 (IQR 25-27). In the past 6 months, the median was 5 sex partners and 54% reported rough sex. RCI was reported by the majority (61%): 26% soreness only, 34% scratches-bleeding. PCI was reported by 53% of men: 32% soreness only, 21% scratches-bleeding. Factors associated with RCI included increasing number of sex partners (soreness: aRR=1.11, p=0.056; scratches-bleeding: aRR=1.15, p=0.01), rough sex (soreness: aRR=11.3, p=0.002; scratches-bleeding: aRR=18.6, p<0.001), versatile sexual positioning (soreness: aRR=8.23, p=0.002; scratches-bleeding: aRR=6.11, p=0.007), and age (soreness: aRR=0.85, p=0.032; scratches-bleeding: aRR=0.79, p=0.008). Though not significant, men diagnosed with GUD were more likely to report rectal scratches-bleeding (23% vs. 14% no RCI). Reported lubricant use by index or partner was not associated with RCI. No factors were associated with PCI at p<0.10.

Conclusions: RCI and PCI were common in this population. Providers should be aware of the high prevalence of RCI to tailor assessment and counseling. Though the potential significance of RCI/PCI in terms of STI/HIV acquisition has not been fully elucidated, preliminary associations with GUD warrant further investigation.