Evidence of changing sexual behaviours and clinical attendance patterns, alongside increasing diagnoses of sexually transmitted infections in MSM and trans persons who have sex with men

Louis W Macgregor, Nathan E Speare, Jane E Nicholls, Lindsey C Harryman, Jeremy P Horwood, Joanna Kesten, Ava Lorenc, Paddy J Horner, Natalie Edelman, Peter Muir, Paul North, Mark Gompels, Katherine Mary Elizabeth Turner

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

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
JournalSexually Transmitted Infections
Publication statusAccepted/In press - 8 Nov 2020

Keywords

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

Fingerprint Dive into the research topics of 'Evidence of changing sexual behaviours and clinical attendance patterns, alongside increasing diagnoses of sexually transmitted infections in MSM and trans persons who have sex with men'. Together they form a unique fingerprint.

Cite this