Socio-Demographic and Clinical Factors Associated with Increasing Bacterial Sexually Transmitted Infection Diagnoses in Men Who Have Sex with Men Accessing Care at a Boston Community Health Center (2005-2015)

• Type of Material: Article
• Authors: Kenneth H. Mayer, The Fenway Institute; Kevin M. Maloney, Emory University; Kenneth Levine, The Fenway Institute; Dana King, The Fenway Institute; Chris Grasso, The Fenway Institute; Douglas S. Krakower, The Fenway Institute; Eli S Rosenberg, Emory University; Stephen L. Boswell, The Fenway Institute
• Language: English
• Date: 2017-10-08
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofx214
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 4
• Issue: 4
• Start Page: ofx214
• End Page: ofx214
• Grant/Funding Information: This work was supported by the National Institutes of Health through the Harvard Center for AIDS Research (P30 AI060354), K23 MH098795, the Emory Center for AIDS Research (P30AI050409).
• Keywords: HIV; men who have sex with men; chlamydia; gonorrhea; syphilis
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background: The reasons why bacterial sexually transmitted infections (BSTIs) are increasing in US men who have sex with men (MSM) have not been fully characterized. Methods: An open cohort of MSM accessing medical care at a Boston community health center was used to assess secular trends in BSTI diagnoses. Frequency of infection and the estimated population size were used to calculate diagnosis rates. Poisson models were fit for multivariable analyses. Results: Between 2005 and 2015, 19 232 men had at least 1 clinic visit. Most (72.4%) were white; 6.0% were black, and 6.1% were Latino. Almost half had documented self-report of identifying as gay (42.6%) or bisexual (3.2%). Most had private health insurance (61.7%); 5.4% had Medicare, 4.6% had Medicaid, and 8.4% reported no insurance. Between 2005 and 2015, BSTI diagnoses increased more than 8-fold. In 2015, of 1319 men who were diagnosed with at least 1 BSTI; 291 were diagnosed with syphilis, 554 with gonorrhea (51.4% rectal, 31.0% urogenital), and 679 with chlamydia (69.1% rectal, 34.3% urogenital). In 2015, 22.7% of BSTIs were diagnosed among HIV-infected patients (15.4% of the clinic population), and 32.8% of BSTIs were diagnosed among HIV-uninfected patients using pre-exposure prophylaxis (PrEP; 10.1% of all men in care). In multivariable analyses, age 18 to 24 years, being HIV-infected, using PrEP, being nonwhite, or reporting Medicaid or not reporting having private insurance or Medicare were independently associated with being diagnosed with a new BSTI. Conclusions: Over the past decade, BSTI diagnosis rates increased in HIV-infected and uninfected MSM, with disproportionate increases in PrEP users, racial and ethnic minority MSM, those aged 25 to 34 years, and those without stable health insurance, warranting focused education, screening, and accessible services for these key subpopulations.