High rates of subsequent asymptomatic STIs and risky sexual behavior in patients initially presenting with primary HIV-1 infection. Clinical Infectious Diseases
Braun, Marzel et al. aimed to identify risk factors and to describe the characteristics of individuals with a sexually transmitted infection (STI). Patients enrolled in the Zurich Primary HIV Infection Study were offered testing for gonorrhea, chlamydia, syphilis, and hepatitis C virus at every clinical visit, independently of signs and symptoms of a STI. They were then asked to complete a behavioral questionnaire that assessed the sexual behavior and symptoms related to a possible STI in the preceding 3 months.
Of 214 participants, 174 (81%) were screened at least once. Most patients were men who have sex with men (MSM) (87.4%). Presenting with a primary HIV infection was associated with higher odds for later risky sexual behavior, as compared with presenting in the chronic phase (odds ratio [OR], 5.58). In total, 79 STIs were detected, reflecting a high period prevalence of 33.3%. Sixty-six percent of patients were asymptomatic. Most common STIs were chlamydia (50.6%), gonorrhea (25.3%), and syphilis (19%). In a multivariable model, engaging in insertive (OR, 6.48) or both insertive and receptive (4.61) anal intercourse, STI symptoms (3.4), and condomless sex (2.06) were positively correlated with a positive screening result. The hazard of an incident STI increased with the presence of STI symptoms (hazard ratio, 3.03) and any recent drug use (2.63).
In conclusion, the study identified a very high prevalence of asymptomatic STIs in patients who initially presented with a primary HIV-1 infection, most of whom were treated with suppressive antiretroviral therapy during the study. The significant associations of STIs with anal intercourse and the reporting of condomless sex or any recent drug use could help to identify a subgroup of high-risk MSM and to prioritize screening and resource allocations.