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Background: In the United States (U.S.), 1 in 2 Black men who have sex with men (MSM) will acquire HIV in their lifetime. Gonorrhea and Chlamydia in genital and extra-genital sites facilitate transmission of HIV among MSM, but data among population-based samples of Black MSM are lacking. We examined the prevalence of and differences by sexual position with gonorrhea and Chlamydia infection among Black MSM in The MARI Study.
Methods: A total of 465 adult Black MSM who reported anal and/or oral sex with another man in the sex months prior to study enrollment and residence in the Jackson, MS or Atlanta, GA metropolitan areas provided pharyngeal and rectal swabs and urine specimens using standard protocols and completed survey about demographics. Chi-square tests assessed differences by sexual position and multivariable logistic regression models assessed whether associations reamined after adjustment for age, ethnicity, and sexual orientation.
Results: Twenty-four percent of Black MSM were infected with either gonorrhea or Chlamydia. Eleven and six percent of participants tested positive for rectal gonorrhea-Chlamydia, respectively; eight and two percent of participated tested positive for pharyngeal gonorrhea-Chlamydia. Only 4% of infections was detected in the urine. Infection was associated with sexual position during sex: self-reported versatile and top sexual position during sex was associated with a greater odds of urethral [Odds ratio (OR)=1.86 and OR=1.43, Ps<0.03, respectively] and anal (OR=1.94 and OR=1.63, Ps<0.02, respectively) gonorrhea and Chlamydia infection in multivariable analyses adjusting for demographic characteristics. No consistent associations were observed between oral infections and sexual position. No differences were observed by HIV-serostatus.
Conclusions: We report a high prevalence of gonorrhea/Chlamydia infection among Black MSM in the Deep South who reported versatile and top sexual positions during sex. The low prevalence of infection in the urine signals the need for aggressive integrated STI screening among Black MSM regardless of reported sexual behaviors.