Does PrEP use lead to higher STI rates among gay and bi men?

From POZ.com

Rates of new sexually transmitted infections (STIs) are much higher among men who have sex with men (MSM) taking Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) than among other MSM. More research is needed, however, to determine whether starting PrEP leads to higher STI rates among MSM.

Publishing their findings in the journal AIDS, researchers conducted a meta-analysis of 18 studies of MSM in which new STI diagnoses were reported. Five of the studies included MSM given PrEP, and 14 were conducted with MSM who were not given PrEP. (One study, the PROUD study, included both a group given PrEP immediately and a group given PrEP on a deferred basis and thus fell into both the PrEP and the non-PrEP categories of studies.)

The researchers found that the rates of new diagnoses of STIs among MSM given PrEP were 25.3 times greater for gonorrhea, 11.2 times greater for chlamydia and 44.6 times greater for syphilis, compared with the rates among MSM not given PrEP. After repeating the analysis but excluding studies conducted before 1999, the researchers found that the results were similar.

Looking to parse apart the contributing factors to the higher rate of STI diagnoses among MSM given PrEP, the meta-analysis’s authors theorized that the regular STI testing that is part of taking PrEP might have led to a higher rate of STI detection. A greater number of sex partners and a higher rate of condomless sex among those given PrEP might also have contributed to their higher STI diagnosis rate.

The study is limited by the fact that, except in the case of PROUD, the researchers compared different populations of MSM from study to study. They also compared groups that tested for STIs at different frequencies and used different variations of STI tests. Additionally, the PrEP studies specifically sought out participants engaging in high-risk sexual behaviors, while the other studies might have had different criteria with regard to sexual risk taking. However, participants in many of the non-PrEP studies were indeed recruited based on some level of reported sexual risk taking.

 

Read the full article.

 

Antibiotic-resistant Gonorrhea on the rise: Are you at risk of drug-resistant STD?

From techtimes.com…

The World Health Organization (WHO) has warned that gonorrhea, a common sexually transmitted disease, has become harder and sometimes even impossible to treat. Neisseria gonorrhoeae, the bacteria that causes the STD, is so smart it evolves to develop resistance against the antibiotics used to treat infection. [Read the WHO report here]

WHO said that decreasing use of condom, poor infection detection rates, urbanization and travel, as well as inadequate or failed treatments all contribute to the rising cases of antibiotic-resistant gonorrhea. “WHO reports widespread resistance to older and cheaper antibiotics. Some countries — particularly high-income ones, where surveillance is best — are finding cases of the infection that are untreatable by all known antibiotics,” WHO said in a statement. WHO experts said that oral sex is driving the spread of super-gonorrhea. In the United States, about two-thirds of those between 15 and 24 years old have had oral sex.

Teodora Wi, from the WHO, said that when antibiotics are used to treat infections of the throat such as normal sore throat, these get mixed with the Neisseria species in the throat, which can lead to resistance.

What makes matters more worrying is that many people with gonorrhea in the throat are not aware they are infected and are more likely to transmit the infection via oral sex. “In the US, resistance [to an antibiotic] came from men having sex with men because of pharyngeal infection,” Wi said.

Read the full article.

Undetectable viral load and HIV prevention: what do gay and bi men need to know?

What does undetectable mean? What about undetectable viral load and HIV transmission? And if I’m living with HIV, can I use “undetectable viral load” as an HIV prevention strategy?

From thebody.com

Risk of HIV transmission is virtually eliminated when people living with HIV are consistently taking effective HIV medication, (known as antiretroviral therapy or ARVs). It’s well-verified by research, and backed up by many years of real world observation: There have been no cases of transmission in couples where the HIV-positive partner was on meds and had “undetectable” viral load test results for at least six months.

But what does this mean for gay and bi men making decisions about sex, whether in ongoing partnerships, casual dating or anonymous encounters?

Get the answers on thebody.com.

Mobile hookup apps account for Philly’s STD spike among gay men: Report

From Metro.us

new report from the Philadelphia Department of Health says mobile so-called hookup apps are contributing to a spike in reported cases of sexually transmitted diseases among gay men. Statistics show those mobile app meetups among men that led to sex doubled from 2015 to 2016, according to the city.

Meanwhile, internet and in-person meetups among men that later led to sex declined through 2016. The report, titled “The resurgence of syphilis among men who have sex with men,” directly links the new cases to the rise of so-called hookup apps like Grindr.

Mobile app users who contracted syphilis made up some two-thirds of the city’s syphilis cases — representing almost the entire increase above prior infection rates, the report concludes. “These apps present a challenge for identifying and treating sexual partners of syphilis cases because the interaction is often anonymous and cannot be re-traced,” according to the report. “Between 2005 and 2016, infectious syphilis diagnoses more than quadrupled, from 208 to 925” in Philadelphia, it stated.

Read the full article.

Gay men syphilis rates over 100x greater than straight men

From medpagetoday.com

The first state-specific analysis of syphilis among men who have sex with men (MSM) shows they have dramatically higher incidence than men whose only sexual partners are female, the CDC is reporting.

Data from 2015, analyzed with a new methodology, show that the incidence of primary and secondary syphilis among MSM was 309.0 cases per 100,000 people, compared with 2.9 per 100,000 among men who reported sex with women only, according to Alex de Voux, PhD, of the CDC’s epidemic intelligence service, and colleagues at the CDC and Emory University in Atlanta.

The disparity was even more marked when the rate among MSM was compared with the 1.8 cases per 100,000 population seen among women, the researchers reported in the April 7 issue of Morbidity and Mortality Weekly Report.

County-by-county data from the U.S. Census Bureau’s American Community Survey included the number of households with a male head-of-household and a male partner, De Voux and colleagues reported, and that information could be used to estimate the MSM population per county.

For the syphilis analysis, the researchers used data from the 44 states that had information on the sex of partners in at least 70% of reported cases. Those states accounted for 83.4% of all 23,872 reported cases in 2015, De Voux and colleagues reported.

State-specific incidence rates among MSM ranged from 73.1 per 100,000 population in Alaska to 748.3 in North Carolina, the investigators found. Syphilis incidence among MSM was highest in the South and West and four of the five states with the highest rates among MSM — Louisiana, Mississippi, North Carolina, South Carolina, and New Mexico — were in the South.

The overall syphilis among MSM was 167.5 times the rate among women, with state-specific rate ratios ranging from 63.7 in Louisiana to 2,140.3 in Hawaii, De Voux and colleagues reported.

Interestingly, the highest overall syphilis rate in the U.S., seen in 1946, was 70.9 cases per 100,000 population — a rate exceeded by the lowest state-specific rate among MSM in 2015: the 73.1 cases per 100,000 observed in Alaska.

The researchers cautioned that the data are based on 44 states and might not reflect the nation as a whole. Similarly, the estimates rely on the American Community Survey data; under-reporting of same-sex households would skew the outcome.

As well, they noted, the analysis did not include cases in which the sex of partners was unknown and if MSM are less likely than other men to report the sex of their partners, the findings might under-estimate the rate of disease among MSM.

Finally, De Voux and colleagues cautioned, not all cases of syphilis are diagnosed and reported.

Editor’s note: To find free Syphilis testing near you, got to gettested.cdc.gov.

New online tool finds providers of HIV Pre-Exposure Prophylaxis (PrEP) in the US

PrEP Locator is a national directory of providers of HIV Pre-Exposure Prophylaxis (PrEP) in the US. PrEP Locator seeks to provide patients access to a national, integrated service including both public and private practice providers. An open source tool, PrEP Locator data and map-based widget are easily accessible via API.

logoThe Locator seeks to serve as a common repository for information regarding providers and clinics that prescribe PrEP. The Locator is an open source tool for those who are managing existing directories to share their resources in a common format, so that patients can access a national, integrated PrEP provider location service that includes both public and private practice PrEP providers. Data will be made accessible with open source tools to facilitate patient access through existing organizational websites and mobile apps.

PrEP Locator is presented by Emory University, in partnership with M•A•C AIDS Fund. The project is led by Dr. Aaron Siegler, Research Assistant Professor of Epidemiology at Emory University’s Rollins School of Public Health. The project is guided by a coalition of partners with expertise in the field of HIV prevention: PleasePrEPMe.org, Greater Than AIDS represented by the Kaiser Family Foundation, National Alliance of State & Territorial AIDS Directors (NASTAD).

Gay men headed for an STD epidemic?

From Slate.com

Earlier this month, Poz magazine’s Benjamin Ryan drew attention to a concerning new study out of Northern California’s health system: Using data gathered from July 2012 through June 2015, researchers found that, among a cohort consisting mostly of same-sex–attracted men on the HIV-prevention regimen PrEP, “quarterly rates of rectal gonorrhea and urethral chlamydia increased steadily and about doubled after one year.” In other words, guys on the fantastically effective pill-a-day Truvada program were avoiding HIV infection—there were no new transmissions for regimen-adherent patients over the study period, in fact—but they seemed to be getting other sexually transmitted diseases relatively often.

Read the full article.