Men who have sex with men (MSM) are at high risk for acquiring HIV infection after diagnosis with other sexually transmitted infections (STIs). Identifying the STIs associated with the greatest risk of subsequent HIV infection could help target prevention interventions, particularly preexposure prophylaxis (PrEP).
Using matched HIV and STI surveillance data from Washington State from January 1, 2007, to June 30, 2013, we calculated the incidence of new HIV diagnoses after different STI diagnoses among MSM. Men entered observation at the time of their first STI diagnosis during the study period and exited at HIV diagnosis or June 30, 2013. Cox proportional hazards regression was used to conduct a global comparison of rates.
From January 1, 2007, to June 30, 2013, 6577 HIV-negative MSM were diagnosed as having 10,080 bacterial STIs at 8371 unique time points and followed for 17,419 person-years. Two hundred eighty (4.3%) men were subsequently diagnosed as having HIV infection for an overall incidence of 1.6 per 100 person-years (95% confidence interval, 1.4–1.8). The estimated incidence of HIV diagnoses among all MSM in the state was 0.4 per 100 person-years. Men who have sex with men were at the greatest risk for HIV diagnosis after being diagnosed as having rectal gonorrhea (HIV incidence, 4.1 per 100 person-years), followed by early syphilis (2.8), urethral gonorrhea (1.6), rectal chlamydial infection (1.6), pharyngeal gonorrhea (1.1), late syphilis (1.0), and urethral chlamydial infection (0.6; P < 0.0001 overall).
Men who have sex with men diagnosed as having rectal gonorrhea and early syphilis were at the greatest risk for being diagnosed as having HIV infection after STI diagnosis. These men should be prioritized for more intensive prevention interventions, including PrEP.
A population-based study in Washington State found that men who have sex with men were at very high risk for acquiring HIV after diagnosis with rectal gonorrhea or early syphilis.
From the Departments of *Medicine and †Epidemiology, University of Washington, Seattle, WA; ‡HIV/STD Program, Public Health–Seattle & King County, Seattle, WA; and §Infectious Disease Assessment Unit, Washington State Department of Health, Olympia, WA
Acknowledgments: The authors thank the disease intervention specialists of Washington State for their work conducting partner services and promoting HIV testing in persons with STIs; Julieann Simon, Claire LaSee, and Jason Carr of the Washington State Department of Health for providing STD surveillance and partner services data; Amy Bennett and Christina Thibault of Public Health–Seattle & King County for providing HIV testing history data from HIV surveillance; and Dr James Hughes of the University of Washington for biostatistics support.
Conflicts of interest and sources of funding: This evaluation reported in this publication was supported by the US Centers for Disease Control and Prevention (CDC PS12-1201) and by National Institute of Allergy and Infectious Diseases, National Cancer Institute, National Institute of Mental Health, National Institute on Drug Abuse, NICHD, National Heart, Lung, and Blood Institute, National Institute on Aging, National Institute of General Medical Sciences, and National Institute of Diabetes and Digestive and Kidney Diseases, of the National Institutes of Health under Award No. P30AI027757.
Dr Golden has received research support from Cempra Pharmaceuticals and Melina Pharmaceuticals. The remaining authors have no potential conflicts of interest to declare.
This work was presented, in part, at the 2014 National STD Prevention Conference in Atlanta, GA.
Correspondence: David A. Katz, PhD, MPH, University of Washington, 325 Ninth Ave, Box 359777, Seattle, WA 98104. E-mail: email@example.com.
Received for publication August 25, 2015, and accepted December 26, 2015.