Epidemiology and Risk Factors for Bacterial STIs Among MSM with HIV and MSM Using PrEP in Madrid, 2022-2024
Luis Ramos-Ruperto, Pablo Ryan, Juan Berenguer, Mar Vera, Luz Martín-Carbonero, Leire Pérez-Latorre, Ignacio De los Santos, Adriana Pinto, María J Vivancos, Eva Orviz, Beatriz Álvarez, José Sanz, Pilar Ruiz-Seco, Rafael Torres, Marta De Miguel, Herminia Esteban, Beatriz López-Centeno, Inmaculada Jarrín, Salvador Resino, José M Bellón, Juan González-García, , L Pérez-Latorre, T Aldámiz-Echevarría, C Díez, F Tejerina, C Fanciulli, C A Fredes, P Catalán, M Ramírez-Schacke, I Gutiérrez, S Carretero, J C López, J M Bellón, J Berenguer, M M Arcos Rueda, J R Arribas López, V Arribas Santos, J I Bernardino de la Serna, C Busca Arenzana, J M Castro Alvarez, A Delgado Nieto, A de Gea Grela, R de Miguel Buckley, R Micán Rivera, M L Martín-Carbonero, R Montejano Sánchez, M L Montes Ramírez, C M Oñoro López, L Ramos Ruperto, J Cano Smith, E Valencia Ortega, J González-García, J Valencia, G Cuevas, M Matarranz, J Troya, P Ryan, M Vera, C Rodríguez, L García-Fraile, A Bautista, C Sáez, A Barrios, A Gutiérrez-Liarte, M Ciudad, A Casen, I De los Santos, A Pinto, M De Lagarde, L Bermejo-Plaza, F Pulido, R Rubio, S Del Campo, M J Vivancos, E Orviz, R Homen, M J Núñez, N Cabello, J Pérez-Somarriba, A Muñoz, J Rodriguez-Añover, V Estrada, B Álvarez, L Prieto-Pérez, E Asensi, A Cabello, M Górgolas, J Sanz, C Hernández, M Novella, P Ruiz-Seco, Jorge Maza, Inés Suárez-García, Patricia González-Ruano, R Torres, M Cervero, B López-Centeno, A Gil-Martin, D Alioto, M J Calvo-Alcántara, M Rava, R Izquierdo, T Gómez, C Marco, I Jarrín, I Martínez, D Sepúlveda, A Virseda, R Amigot, M J Muñoz, S Resino, B Brazal, M De Miguel, H EstebanAbstract
Background
Bacterial sexually transmitted infections (bSTIs) are frequent among men who have sex with men (MSM) with HIV or using pre-exposure prophylaxis (PrEP). Prospective comparisons within the same healthcare system are limited.
Methods
We conducted a prospective multicenter study in Madrid (2022–2024), with 12-month follow-up and semiannual screening for MSM with HIV and quarterly screening for PrEP users. Associations with incident bSTIs were assessed using Poisson regression with robust standard errors and multiple imputation. Monthly condomless anal intercourse (CLAI) partner count was modeled using a restricted cubic spline.
Results
Among 1,372 participants (733 with HIV and 639 using PrEP), 39.0% had ≥1 bSTI at baseline or during follow-up. Baseline prevalence was 16.8% and 19.7%, respectively. Incidence rates per 100 person-years among MSM with HIV versus PrEP users were 14.9 versus 21.4 for gonorrhea, 10.9 versus 15.9 for chlamydia, and 11.6 versus 9.4 for syphilis. Relative to one CLAI partner/month, adjusted incidence rate ratios (IRRs) were 0.81, 1.18, 1.42, and 1.53 for zero, two, four, and eight partners, respectively (P for nonlinearity=0.001). Chemsex (adjusted IRR, 1.33; 95% CI, 1.05–1.70) and screening rate (adjusted IRR per additional visit/year, 1.15; 95% CI, 1.04–1.27) were associated with higher incidence; older age and being born in Spain were associated with lower incidence.
Conclusions
bSTIs were frequent in both groups. Higher CLAI partner counts, chemsex, and higher screening rates were independently associated with higher detected STI incidence, while no independent association with study group was identified.