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High Prevalence of Sexually Transmitted Infections in HIV-Infected Men During Routine Outpatient Visits in the Netherlands

Heiligenberg, Marlies MD*†; Rijnders, Bart MD, PhD‡; Schim van der Loeff, Maarten F. MD, PhD*†; de Vries, Henry J. C. MD, PhD*§¶; van der Meijden, Willem I. MD∥; Geerlings, Suzanne E. MD, PhD†; Fennema, Han S. A. MD, PhD*; Prins, Maria PhD*†; Prins, Jan M. MD, PhD†

Sexually Transmitted Diseases: January 2012 - Volume 39 - Issue 1 - pp 8-15
doi: 10.1097/OLQ.0b013e3182354e81
Original Study

Background: In the Netherlands, no guidelines exist for routine sexually transmitted infection (STI) screening of human immunodeficiency virus (HIV)-infected men having sex with men (MSM). We assessed prevalence and factors associated with asymptomatic STI.

Methods: MSM visiting HIV outpatient clinics of academic hospitals were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), syphilis, and hepatitis B and C infection. Prevalence and risk factors were studied using logistic regression.

Results: In total, 659 MSM were included between 2007 and 2008. STI were found in 16.0% of patients, mostly anal CT and syphilis. One new hepatitis B and 3 new hepatitis C infections were identified. In multivariate analyses, any STI (syphilis, CT, or NG) was associated with patient's age below 40 years (odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.3–5.0), having had sex with 2 or more sexual partners (OR 2.1, 95% CI: 1.2–3.5), the use of the same sexual toys with a sexual partner (OR 2.2, 95% CI: 1.0–4.9), and enema use before sex (OR: 2.3, 95% 1.2–4.2). Syphilis was independently associated with fisting with gloves versus no fisting (OR: 4.9, 95% CI: 1.7–13.7) and with rimming (OR: 5.0, 95% CI: 1.7–15.0). CT or NG were associated with age below 45 years (age 40–44 years: OR: 2.4, 95% CI: 1.1–5.3; age <40 years: OR: 2.4, 95% CI: 1.1–5.4), enema use before sex (OR: 2.4, 95% CI: 1.3–4.4) and drug use during sex (OR: 2.4, 95% CI: 1.4–4.0).

Conclusions: High-risk sexual behavior was very common, and 16% of HIV-infected MSM in HIV care had an asymptomatic STI, mostly anal CT and syphilis. Development of STI screening guidelines is recommended.

In HIV-infected MSM in the Netherlands, high-risk sexual behavior was very common, and 16% had an asymptomatic STI, mostly anal CT and syphilis. Development of STI screening guidelines is recommended.

From the *Department of Research, Cluster of Infectious Diseases, Health Service Amsterdam, Amsterdam, the Netherlands; †Division of Infectious Diseases, Tropical Medicine and AIDS, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, the Netherlands; ‡Division of Infectious Diseases, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands; §Department of Dermatology, Academic Medical Centre, Amsterdam, the Netherlands; ¶Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands; and ∥Department of Dermatology, Erasmus Medical Centre, Rotterdam, the Netherlands

The authors thank all the participants and HIV physicians and HIV nurses of the Departments of Internal Medicine of the Erasmus MC in Rotterdam (especially Danny Brok) and the AMC in Amsterdam, for help with inclusion of patients. The authors also thank the colleagues of the Public Health Laboratory (Health Service Amsterdam), and the Microbiology Laboratories of the Erasmus MC and the AMC, especially Arjen Speksnijder, Karin Adams, and Douwe Abma for CT, LGV, and NG testing; Hans Zaaijer for providing HBV and HCV test results; Anita Buskermolen for syphilis testing; Suzanne Jurriaans and Margreet Bakker for their help with retrieving serum samples from participants; and Ronald Geskus for critical reading.

Supported by funds from the National Institute for Public Health and the Environment, Centre for Infectious Diseases Control, the Netherlands and by grant 7115 0001 from ZonMw, the Netherlands Organisation for Health Research and Development.

Presented previously at NCHIV, Amsterdam, 2009 and CROI, San Francisco, 2010.

The funding agencies had no role in the study design, data collection, data analysis, data interpretation, or the writing of the article.

Correspondence: Marlies Heiligenberg, MD, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, the Netherlands. E-mail: mheiligenberg@ggd.amsterdam.nl.

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Received for publication February 21, 2011, and accepted August 4, 2011.

© Copyright 2012 American Sexually Transmitted Diseases Association