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High HIV incidence in men who have sex with men following an early syphilis diagnosis: is there room for pre-exposure prophylaxis as a prevention strategy?

Abstract HIV pre-exposure prophylaxis (PrEP) is becoming a pivotal strategy for HIV prevention. Understanding the impact of risk factors for HIV transmission to identify those at highest risk would favour the implementation of PrEP, currently limited by costs. In this service evaluation, we estimated the incidence of bacterial STIs in men who have sex with men (MSM) diagnosed with early syphilis attending a London sexual health clinic according to their HIV status. In addition, we estimated the incidence of HIV infection in HIV-negative MSM, following a diagnosis of early syphilis.
PMID
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Authors

Mayor MeshTerms

Homosexuality, Male

Pre-Exposure Prophylaxis

Keywords

GAY MEN

HIV

PREVENTION

SYPHILIS

Journal Title sexually transmitted infections
Publication Year Start




PMID- 28729516
OWN - NLM
STAT- MEDLINE
DA  - 20170721
DCOM- 20170807
LR  - 20170807
IS  - 1472-3263 (Electronic)
IS  - 1368-4973 (Linking)
VI  - 93
IP  - 5
DP  - 2017 Aug
TI  - High HIV incidence in men who have sex with men following an early syphilis
      diagnosis: is there room for pre-exposure prophylaxis as a prevention strategy?
PG  - 320-322
LID - 10.1136/sextrans-2016-052865 [doi]
AB  - OBJECTIVES: HIV pre-exposure prophylaxis (PrEP) is becoming a pivotal strategy
      for HIV prevention. Understanding the impact of risk factors for HIV transmission
      to identify those at highest risk would favour the implementation of PrEP,
      currently limited by costs. In this service evaluation, we estimated the
      incidence of bacterial STIs in men who have sex with men (MSM) diagnosed with
      early syphilis attending a London sexual health clinic according to their HIV
      status. In addition, we estimated the incidence of HIV infection in HIV-negative 
      MSM, following a diagnosis of early syphilis. METHODS: We undertook a
      retrospective case note review of all MSM patients diagnosed with early syphilis 
      between January and June 2014. A number of sexual health screens and diagnoses of
      chlamydia, gonorrhoea and HIV were prospectively analysed following the syphilis 
      diagnosis. RESULTS: 206 MSM were diagnosed with early syphilis. 110 (53%) were
      HIV-negative at baseline, 96 (47%) were HIV-positive. Only age (37 vs 32 years,
      p=0.0005) was significantly different according to HIV status of MSM at baseline.
      In HIV-negative versus HIV-positive MSM, incidence of rectal chlamydia infection 
      at follow-up was 27 cases vs 50/100 person-years of follow-up (PYFU) (p=0.0039), 
      33 vs 66/100 PYFU (p=0.0044) for rectal gonorrhoea and 10 vs 26/100 PYFU
      (p=0.0044) for syphilis reinfection, respectively. Total follow-up for 110
      HIV-negative MSM was 144 person-years. HIV incidence was 8.3/100 PYFU (CI 4.2 to 
      14). CONCLUSIONS: A diagnosis of early syphilis carries a high risk of consequent
      HIV seroconversion and should warrant prioritised access to prevention measures
      such as PrEP and regular STI screening to prevent HIV transmission.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://www.bmj.com/company/products-services/rights-and-licensing/.
FAU - Girometti, Nicolo
AU  - Girometti N
AD  - Infectious Diseases Unit, S. Orsola Malpighi Hospital, University of Bologna,
      Bologna, Italy.
AD  - Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.
FAU - Gutierrez, Angela
AU  - Gutierrez A
AD  - Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.
FAU - Nwokolo, Nneka
AU  - Nwokolo N
AD  - Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.
FAU - McOwan, Alan
AU  - McOwan A
AD  - Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.
FAU - Whitlock, Gary
AU  - Whitlock G
AD  - Chelsea & Westminster Hospital NHS Foundation Trust, London, UK.
LA  - eng
PT  - Journal Article
DEP - 20161019
PL  - England
TA  - Sex Transm Infect
JT  - Sexually transmitted infections
JID - 9805554
SB  - IM
MH  - Adult
MH  - Chlamydia Infections/epidemiology/microbiology/virology
MH  - Gonorrhea/epidemiology/microbiology/virology
MH  - HIV Infections/*complications/epidemiology/*prevention & control/virology
MH  - HIV Seropositivity/epidemiology/microbiology/virology
MH  - *Homosexuality, Male
MH  - Humans
MH  - Incidence
MH  - London/epidemiology
MH  - Male
MH  - Middle Aged
MH  - *Pre-Exposure Prophylaxis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sexual Behavior
MH  - Sexually Transmitted Diseases/epidemiology
MH  - Syphilis/*complications/diagnosis/epidemiology/virology
MH  - Young Adult
OTO - NOTNLM
OT  - GAY MEN
OT  - HIV
OT  - PREVENTION
OT  - SYPHILIS
COI - Competing interests: None declared.
EDAT- 2017/07/22 06:00
MHDA- 2017/08/08 06:00
CRDT- 2017/07/22 06:00
PHST- 2016/08/25 [received]
PHST- 2016/09/24 [revised]
PHST- 2016/09/29 [accepted]
AID - sextrans-2016-052865 [pii]
AID - 10.1136/sextrans-2016-052865 [doi]
PST - ppublish
SO  - Sex Transm Infect. 2017 Aug;93(5):320-322. doi: 10.1136/sextrans-2016-052865.
      Epub 2016 Oct 19.