Since 1996, there has been a resurgence in sexually transmitted infections (STIs) among men who have sex with men (MSM) in Western Europe. This has coincided with a significant decrease in HIV-associated mortality following the introduction of highly active antiretroviral therapies (HAART) and a corresponding increase in the number of MSM living with HIV. Levels of unprotected anal intercourse have also increased. In this article, we use STI surveillance data from a number of Western European countries to better understand the contribution of HIV-positive MSM to the recent increase in STIs.
Published literature, surveillance reports, and ad hoc publications relating to HIV prevalence trends and STIs among HIV-positive MSM in Western Europe were reviewed.
Post-HAART, HIV prevalence among community samples of MSM ranged from 5% to 18%. HIV prevalence among MSM diagnosed with an STI was substantially higher. On average, HIV prevalence among MSM diagnosed with syphilis in 11 countries was 42% (range 14%–59%). Most HIV-positive MSM with syphilis were aware of their HIV status. In England and Wales, 32% of MSM with gonorrhea were HIV-positive in 2004. Outbreaks of lymphogranuloma venereum have been documented in 9 countries; HIV-positive MSM accounted for 75% of cases on average (range 0%–92%). Cases of sexually transmitted hepatitis C have been predominantly identified among HIV-positive MSM in Rotterdam, Paris, Amsterdam, and the United Kingdom.
In Western Europe, STIs have been disproportionately diagnosed among HIV-positive MSM post-HAART. Improved survival coupled with serosorting among HIV-positive MSM appears to explain the high prevalence of HIV among MSM with STIs. STI transmission among HIV-positive men will have contributed substantially to increasing STI trends seen among MSM in Western Europe, since 1996. These findings highlight the need for routine STI testing among HIV-positive MSM as well as safer sex messages highlighting the implications of STI coinfection.
A review of the literature found that since the introduction of highly active antiretroviral therapies, STIs have been disproportionately diagnosed among HIV positive men who have sex with men in Western Europe.
From *City University, Institute of Health Sciences, St. Bartholomew School of Nursing and Midwifery, London, United Kingdom; and †Health Protection Agency Centre for Infections, London, United Kingdom
The authors extend their thanks to Drs. Eline op de Coul, Femke Koedijk, Michael Boclow, and Anthony Nardone for providing, or clarifying, data that are presented in this manuscript. The authors thank the reviewers for their insightful comments.
Contribution of authors: SD conceived the idea for the article with input from JE. SD undertook the literature review and wrote the first draft. JE and BE commented on subsequent drafts. All authors read and approved the final draft. SD is currently registered for a PhD at City University, London.
Correspondence: Sarah Dougan, City University, Institute of Health Sciences, 24 Chiswell Street, London EC1Y 4TY, United Kingdom. E-mail: email@example.com.
Received for publication September 5, 2006, and accepted February 2, 2007.