Gonorrhea, Chlamydia and Early Syphilis Among HIV-Infected and Uninfected Men Who Have Sex with Men As Risk Markers to Target High Impact HIV Prevention Interventions

Background:  Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections and early syphilis are markers of recent high-risk sexual behaviors and can facilitate HIV transmission. The presence of these infections can be used to target specific prevention interventions for men who have sex with men (MSM) visiting STD clinics.

Methods:  MSM visiting the Denver Metro Health (STD) Clinic (DMHC) are offered NG/CT nucleic acid amplification testing for all exposed anatomical sites as well as syphilis and HIV serologic testing. We analyzed NG and CT infections (urethral, pharyngeal, and rectal) and early (primary, secondary, early latent) syphilis among 3 groups of MSM visiting DMHC: 1) known to be HIV infected; 2) HIV uninfected; and 3) newly HIV diagnosed at the clinic visit.  

Results:  Between 2013 and 2015, the number of MSM visiting DMHC grew by 40.5%, making up 46% of all men and 20% of all patients in 2015. Among 2,008 MSM making new visits to DMHC in 2015, a total of 854 NG and CT infections were detected: 212 rectal CT, 188 rectal NG, 179 pharyngeal NG, 132 urethral NG, 101 urethral CT and 44 pharyngeal CT.  Early syphilis was diagnosed among 79 MSM. At least one infection was present among 19/28 (67.9%) MSM newly diagnosed with HIV and among 108/224 (48.2%) known HIV-infected MSM, compared to 614/1756 (34.9%) HIV-uninfected MSM (p<0.001, Fisher Exact Test).

Conclusions:  Using NG and CT infections and early syphilis as risk markers, subgroups of MSM at highest risk for HIV transmission/acquisition can be identified and should be targeted for high intensity HIV prevention. For HIV uninfected MSM this includes HIV pre-exposure prophylaxis. NG/CT positive MSM known to be HIV infected should be assessed for current ARV use and HIV viral load status and, if currently not in care, be offered (re-)linkage services and prevention counseling.