title: Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion.
abstract: BACKGROUND
  HIV infection continues to disproportionately affect men who have sex with men (MSM). Identification of modifiable risk factors for HIV infection among MSM is critical for effective prevention.
  
  
  METHODS
  We examined the relationship between number of prior rectal Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) infections and HIV seroconversion in a retrospective cohort of HIV-uninfected MSM diagnosed with a rectal infection. Number of rectal CT or GC infections in the prior 2 years was the primary exposure. Univariate and multivariate Cox proportional hazards models were used to estimate the association between prior rectal infections and HIV seroconversion.
  
  
  RESULTS
  A total of 541 MSM were observed for a total of 1197.96 person-years. Overall, 27 (4.99%) of the MSM became infected with HIV, for an estimated annual incidence of 2.25% [95% confidence interval (CI): 1.49 to 3.26]. In multivariate analysis, an early syphilis diagnosis in the past 2 years (hazard ratio = 4.04, 95% CI: 1.19 to 13.79) and 2 prior CT or GC rectal infections in the past 2 years (hazard ratio = 8.85, 95% CI: 2.57 to 30.40) were associated with incident HIV.
  
  
  CONCLUSIONS
  Among MSM infected with rectal GC or CT, a history of 2 additional prior rectal infections was associated with an 8-fold increased risk of HIV infection. HIV-uninfected MSM with multiple rectal infections represent a population in need of innovative HIV-prevention interventions.
authors.affiliation: Epidemiology, Research and Surveillance, STD Prevention and Control Services, San Francisco Department of Public Health, San Francisco, CA 94103, USA. kyle.bernstein@sfdph.org
authors.forename: Kyle T
authors.initials: KT
authors.lastname: Bernstein
authors.forename: Julia L
authors.initials: JL
authors.lastname: Marcus
authors.forename: Giuliano
authors.initials: G
authors.lastname: Nieri
authors.forename: Susan S
authors.initials: SS
authors.lastname: Philip
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000150:complications* / Q000453:epidemiology*; D006069:Gonorrhea / Q000150:complications* / Q000453:epidemiology*; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult