title: Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: the Health in Men Study.
abstract: BACKGROUND
  Early detection and treatment of bacterial sexually transmitted infections has been advocated as an HIV prevention strategy.
  
  
  OBJECTIVE
  To inform screening guidelines, the incidence and risk factors for urethral and anal gonorrhoea and chlamydia were studied in a prospective cohort of community-based HIV negative homosexual men in Sydney, New South Wales, Australia.
  
  
  METHODS
  All participants were offered annual screening for gonorrhoea and chlamydia (study-visit diagnoses) on urine and anal swabs using nucleic acid amplification. Participants also reported diagnoses of gonorrhoea and chlamydia made elsewhere between interviews (interval diagnoses). All diagnoses were summed to create a combined incidence rate, and detailed data on specific sexual practices with casual and regular partners were collected.
  
  
  RESULTS
  Among 1427 men enrolled, the combined incidence rates were 3.49 and 2.96 per 100 person-years for urethral and anal gonorrhoea, respectively; and 7.43 and 4.98 per 100 person-years for urethral and anal chlamydia, respectively. Urethral infections were associated with unprotected anal intercourse (UAI) with HIV-positive partners (hazard ratio (HR) = 2.58, 95% CI 1.10 to 6.05 for urethral gonorrhoea) and with frequent insertive oral sex (p for trend 0.007 for urethral chlamydia). Anal infections were associated with receptive UAI (p for trend 0.001 for both anal gonorrhoea and chlamydia) and other receptive anal sexual practices. Stratified analyses showed the independence of the associations of insertive oral sex with urethral infections and of non-intercourse receptive anal practices with anal infections.
  
  
  CONCLUSIONS
  Incident gonorrhoea and chlamydia were common. Risk behaviours for both urethral and anal infections were not restricted to UAI. Screening that includes tests for anal and urethral infections should be considered for all sexually active homosexual men, not just for those who report UAI.
authors.affiliation: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, New South Wales, Australia. jjin@nchecr.unsw.edu.au
authors.forename: F
authors.initials: F
authors.lastname: Jin
authors.forename: G P
authors.initials: GP
authors.lastname: Prestage
authors.forename: L
authors.initials: L
authors.lastname: Mao
authors.forename: S C
authors.initials: SC
authors.lastname: Kippax
authors.forename: C M
authors.initials: CM
authors.lastname: Pell
authors.forename: B
authors.initials: B
authors.lastname: Donovan
authors.forename: P H
authors.initials: PH
authors.lastname: Cunningham
authors.forename: D J
authors.initials: DJ
authors.lastname: Templeton
authors.forename: J M
authors.initials: JM
authors.lastname: Kaldor
authors.forename: A E
authors.initials: AE
authors.lastname: Grulich
mesh_terms: D000328:Adult; D000368:Aged; D001004:Anus Diseases / Q000453:epidemiology* / Q000382:microbiology; D002690:Chlamydia Infections / Q000453:epidemiology*; D015331:Cohort Studies; D006069:Gonorrhea / Q000453:epidemiology*; D018023:HIV Seronegativity; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011446:Prospective Studies; D012307:Risk Factors; D014522:Urethral Diseases / Q000453:epidemiology* / Q000382:microbiology