Evidence of changing sexual behaviours and clinical attendance patterns, alongside increasing diagnoses of STIs in MSM and TPSM

Louis MacGregor, Nathan Speare, Jane Nicholls, Lindsey Harryman, Jeremy Horwood, Joanna May Kesten, Ava Lorenc, Patrick Horner, Natalie Lois Edelman, Peter Muir, Paul North, Mark Gompels, Katy M E Turner

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background: Due to rising numbers of STI diagnosis and increasing prevalence of anti-microbial resistance, we explored trends in STI testing frequency and diagnoses, alongside sexual decision-making and attitudes concerning condom use and HIV pre-exposure prophylaxis (PrEP) at a large urban UK sexual health clinic.
Methods: We examined 66,528 electronic patient records (EPR) covering 40,321 attendees between 2016-2019; 3,977 of whom were men or trans-persons-who-have-sex-with-men (MSM/TPSM). We also explored responses from MSM/TPSM attendees sent an electronic questionnaire between November 2018-2019 (n=1,975) examining behaviours/attitudes towards PrEP. We measured trends in STI diagnoses and sexual behaviours including condomless anal intercourse (CAI), utilising linear and logistic regression analyses.
Results: Tests resulting in gonorrhoea, chlamydia or syphilis diagnoses increased among MSM/TPSM from 13.5%-18.5% between 2016-2019 (p<0.001). The average MSM/TPSM STI testing frequency increased from 1.5/person/year to 2.1/person/year (p=0.017). Gay MSM/TPSM had the highest proportions of attendances resulting in diagnoses, increasing from 15.1%-19.6% between 2016-2019 (p<0.001) compared to bisexual/other MSM/TPSM increasing from 6.9%-14.5% (p<0.001); alongside smaller but significant increases in non-MSM/TPSM from 5.9-7.7% (p<0.001). The proportion of MSM/TPSM clinic attendees reporting CAI in the previous 3 months prior to at least one appointment in a given year increased significantly from 40.6%-45.5% between 2016-2019 (p<0.0001) and average number of partners from 3.8-4.5 (p=0.002). Of 617 eligible questionnaire responses, 339/578 (58.7%) HIV-negative and 29/39 (74.4%) HIV-positive MSM/TPSM indicated they would be more likely to have CAI with someone on PrEP versus not on PrEP. 358/578 (61.9%) HIV-negative respondents said that PrEP use would make them more likely to have CAI with HIV-negative partners.
Conclusion: Rising numbers of STI diagnoses amongst MSM/TPSM are not attributable to increased testing alone. Increased CAI and number of partners may be attributable to evolving sexual decision-making among PrEP users and their partners. Proportionally, bisexual/other MSM/TPSM have the steepest increase in STI diagnoses.
Original languageEnglish
Pages (from-to)507-513
Number of pages7
JournalSexually Transmitted Infections
Volume97
Issue number7
Early online date19 Aug 2021
DOIs
Publication statusPublished - Nov 2021

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Keywords

  • HIV
  • syphilis
  • Gonorrhea
  • Chlamydia
  • men who have sex with men
  • transpersons who have sex with men
  • pre-exposure prophylaxis
  • antimicrobial resistance

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