title: High prevalence of sexually transmitted infections in HIV-infected men during routine outpatient visits in the Netherlands.
abstract: BACKGROUND
  In the Netherlands, no guidelines exist for routine sexually transmitted infection (STI) screening of human immunodeficiency virus (HIV)-infected men having sex with men (MSM). We assessed prevalence and factors associated with asymptomatic STI.
  
  
  METHODS
  MSM visiting HIV outpatient clinics of academic hospitals were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), syphilis, and hepatitis B and C infection. Prevalence and risk factors were studied using logistic regression.
  
  
  RESULTS
  In total, 659 MSM were included between 2007 and 2008. STI were found in 16.0% of patients, mostly anal CT and syphilis. One new hepatitis B and 3 new hepatitis C infections were identified. In multivariate analyses, any STI (syphilis, CT, or NG) was associated with patient's age below 40 years (odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.3-5.0), having had sex with 2 or more sexual partners (OR 2.1, 95% CI: 1.2-3.5), the use of the same sexual toys with a sexual partner (OR 2.2, 95% CI: 1.0-4.9), and enema use before sex (OR: 2.3, 95% 1.2-4.2). Syphilis was independently associated with fisting with gloves versus no fisting (OR: 4.9, 95% CI: 1.7-13.7) and with rimming (OR: 5.0, 95% CI: 1.7-15.0). CT or NG were associated with age below 45 years (age 40-44 years: OR: 2.4, 95% CI: 1.1-5.3; age <40 years: OR: 2.4, 95% CI: 1.1-5.4), enema use before sex (OR: 2.4, 95% CI: 1.3-4.4) and drug use during sex (OR: 2.4, 95% CI: 1.4-4.0).
  
  
  CONCLUSIONS
  High-risk sexual behavior was very common, and 16% of HIV-infected MSM in HIV care had an asymptomatic STI, mostly anal CT and syphilis. Development of STI screening guidelines is recommended.
authors.affiliation: Department of Research, Cluster of Infectious Diseases, Health Service Amsterdam, Amsterdam, The Netherlands. mheiligenberg@ggd.amsterdam.nl
authors.forename: Marlies
authors.initials: M
authors.lastname: Heiligenberg
authors.forename: Bart
authors.initials: B
authors.lastname: Rijnders
authors.forename: Maarten F
authors.initials: MF
authors.lastname: Schim van der Loeff
authors.forename: Henry J C
authors.initials: HJ
authors.lastname: de Vries
authors.forename: Willem I
authors.initials: WI
authors.lastname: van der Meijden
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
authors.forename: Han S A
authors.initials: HS
authors.lastname: Fennema
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010045:Outpatients; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D013587:Syphilis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D014210:Treponema pallidum / Q000302:isolation & purification