AUTHOR=Wu Tzong-Yow , Lin Kuan-Yin , Su Li-Hsin , Sun Hsin-Yun , Huang Yu-Shan , Liu Wang-Da , Liu Wen-Chun , Chang Lan-Hsin , Chang Sui-Yuan , Hung Chien-Ching 

TITLE=Sexually transmitted coinfections among at-risk HIV-positive MSM: implications for optimal preemptive treatment

JOURNAL=Frontiers in Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1328589

DOI=10.3389/fmed.2024.1328589

ISSN=2296-858X

ABSTRACT=<sec id="sec1"><title>Background</title><p>Concurrent sexually transmitted infections (STIs) are common in sexually active populations. We aimed to estimate the prevalence and coinfection rates of bacterial STIs among sexually active, HIV-positive men who have sex with men (MSM), and to assess the potential benefits of different combination treatment regimens in managing concurrent bacterial STIs.</p></sec><sec id="sec2"><title>Methods</title><p>From September 2021 to September 2023, HIV-positive MSM underwent STI testing when they had symptoms suggestive of STIs or recently acquired hepatitis C virus (HCV) infection or early syphilis. The oral rinse, rectal swab, and urethral swab specimens were tested for <italic>Chlamydia trachomatis</italic>, <italic>Neisseria gonorrhoeae</italic>, <italic>Mycoplasma</italic> spp., <italic>Ureaplasma</italic> spp., and <italic>Trichomonas vaginalis</italic> with the use of multiplex real-time polymerase-chain-reaction assays. The estimated coinfection rates were used to evaluate the benefits of different combination treatment regimens for managing coinfections.</p></sec><sec id="sec3"><title>Results</title><p>During the study period, 535 participants (median age, 37 years; and CD4 count, 615 cells/mm<sup>3</sup>) were enrolled. On their first visits, at least one bacterial pathogen was detected in 57.9% and concomitant bacterial infections were found in 32.9% of the participants. The most commonly identified pathogen was <italic>U. urealyticum</italic> (36.3%), followed by <italic>C. trachomatis</italic> (22.8%), and <italic>N. gonorrhoeae</italic> (19.8%). The factors associated with any bacterial STIs included older age (per 1-year increase, adjusted odds ratio [AOR], 0.97; 95% confidence interval [CI], 0.95–1.00), early syphilis (AOR, 1.87; 95% CI, 1.22–2.84), and having more than 5 sex partners in the preceding 3 months (AOR, 2.08, 95% CI, 1.07–4.06). A combination therapy of benzathine penicillin G with a 7-day course of doxycycline could simultaneously treat 27.1% of <italic>C. trachomatis</italic> coinfections in participants with early syphilis, while a combination therapy of ceftriaxone with doxycycline could simultaneously treat 40.6% of chlamydial coinfections in participants with gonorrhea.</p></sec><sec id="sec4"><title>Conclusion</title><p>Bacterial STIs were prevalent and concomitant infections were not uncommon among sexually active, HIV-positive MSM, supporting regular screening for bacterial STIs. The effectiveness of preemptive use of doxycycline as combination therapy for concurrent STIs warrants more investigations.</p></sec>