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Farfour E, Dimi S, Chassany O, Fouéré S, Valin N, Timsit J, Ghosn J, Duvivier C, Duracinsky M, Zucman D. Trends in asymptomatic STI among HIV-positive MSM and lessons for systematic screening. PLoS One 2021; 16:e0250557. [PMID: 34166379 PMCID: PMC8224955 DOI: 10.1371/journal.pone.0250557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 04/11/2021] [Indexed: 11/18/2022] Open
Abstract
The burden of STIs is particularly high in HIV-infected MSM patients. A recent increase in STIs prevalence has been noticed in the US and western European countries. We aim to assess trends in asymptomatic STIs following the publication of recommendations for STIs screening, i.e. Chlamydia (CT) and gonorrhea (NG). Seventeen centers located in the Paris area participated in the study. All asymptomatic HIV-infected MSM patients attending a follow up consultation were proposed to participated in the study. Asymptomatic patients were included over 2 periods: period 1 from April to December 2015 and period 2 from September to December 2017. Etiologic diagnosis of STIs including hepatitis B, C, syphilis, was performed using a serological test, including a non-treponemal titer with a confirmatory treponemal assay for syphilis. CT and NG were screened using a nucleic acid amplification test (NAATs) on 3 anatomical sites, i.e. urine, rectal and pharyngeal. Overall, 781 patients were included: 490 and 291 in periods 1 and 2 respectively. Asymptomatic CT, NG, and syphilis were diagnosed in 7.5%, 4.8% and, 4.2% respectively. The rate of patients having a multisite asymptomatic infection was 10.2% and 21.1% for CT and NG respectively. The most frequently involved anatomical sites for CT and NG asymptomatic infections were anorectal (66.1% and 55.2% respectively) and pharyngeal (47.4% and 60.5% respectively). CT and NG asymptomatic infection increased by 1.3- and 2-fold respectively between the two periods while syphilis decreased by 3 folds. Our results encourage to reconsider multisite screening for CT and NG in asymptomatic HIV positive MSM as the yield of screening urinary samples only might be low. Despite the more systematic STI screening of asymptomatic HIV positive MSM the prevalence of STI is increasing in MSM in France. Therefore, this strategy has not led to alter CT and NG transmission. The decrease of syphilis might involve self-medication by doxycycline, and the intensification of syphilis screening.
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Affiliation(s)
- Eric Farfour
- Service de Biologie Clinique, Hôpital Foch, Suresnes, France
| | - Svetlane Dimi
- Centre de Vaccinations Internationales et Médecine de Voyage, Creil, France
| | - Olivier Chassany
- Patient-Reported Outcomes Research, Sorbonne Paris Cité, Université Paris-Diderot, Paris, France.,Unité de Recherche Clinique en Economie de la Santé, Hôpital Hôtel-Dieu, Assistance Publique Hôpital de Paris, Paris, France
| | - Sébastien Fouéré
- Centre for Genital and Sexually Transmitted Diseases, Dermatology Department, APHP Hospital Saint-Louis, Paris, France
| | - Nadia Valin
- Hôpital Saint Antoine, Service des Maladies Infectieuses, Paris, France
| | - Julie Timsit
- Centre for Genital and Sexually Transmitted Diseases, Dermatology Department, APHP Hospital Saint-Louis, Paris, France
| | - Jade Ghosn
- Assistance Publique-Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Groupe Hospitalier Paris Nord Val de Seine, Site Bichat-Claude Bernard, Paris, France.,INSERM UMR 1137 IAME, PRES Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Paris, France.,IHU Imagine, Paris, France.,Institut Cochin, CNRS 8104, INSERM U1016, RIL Team: Retrovirus, Infection and Latency, Université de Paris, Paris, France.,Institut Pasteur, Centre Médical de l'Institut Pasteur, Paris, France
| | - Martin Duracinsky
- Patient-Reported Outcomes Research, Sorbonne Paris Cité, Université Paris-Diderot, Paris, France.,Unité de Recherche Clinique en Economie de la Santé, Hôpital Hôtel-Dieu, Assistance Publique Hôpital de Paris, Paris, France.,Médecine Interne et Immunologie Clinique, Hôpital Bicêtre, Assistance Publique Hôpital de Paris, Paris, France
| | - David Zucman
- Réseau Ville-Hôpital, Service de Médecine Interne, Hôpital Foch, Suresnes, France
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