title: Low prevalence of methicillin-resistant Staphylococcus aureus among men who have sex with men attending an STI clinic in Amsterdam: a cross-sectional study.
abstract: OBJECTIVE
  Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is common among men who have sex with men (MSM) in the USA. It is unknown whether this is also the case in Amsterdam, the Netherlands.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Sexually transmitted infection outpatient low-threshold clinic, Amsterdam, the Netherlands.
  
  
  METHODS
  Between October 2008 and April 2010, a total of 211 men were included, in two groups: (1) 74 MSM with clinical signs of a skin or soft tissue infection (symptomatic group) and (2) 137 MSM without clinical signs of such infections (asymptomatic group).
  
  
  METHODS
  S aureus and MRSA infection and/or colonisation. Swabs were collected from the anterior nasal cavity, throat, perineum, penile glans and, if present, from infected skin lesions. Culture for S aureus was carried out on blood agar plates and for MRSA on selective chromagar plates after enrichment in broth. If MRSA was found, the spa-gene was sequenced.
  
  
  METHODS
  Associated demographic characteristics, medical history, risk factors for colonisation with S aureus and high-risk sexual behaviour were collected through a self-completed questionnaire.
  
  
  RESULTS
  The prevalence of S aureus colonisation in the nares was 37%, the pharynx 11%, the perianal region 12%, the glans penis 10% and in skin lesions 40%. In multivariable analysis adjusting for age, anogenital S aureus colonisation was significantly associated with the symptomatic group (p=0.01) and marginally with HIV (p=0.06). MRSA was diagnosed in two cases: prevalence 0.9% (95% CI 0.1% to 3.4%)). Neither had CA-MRSA strains.
  
  
  CONCLUSIONS
  CA-MRSA among MSM in Amsterdam is rare. Genital colonisation of S aureus is not associated with high-risk sexual behaviour.
authors.affiliation: Cluster of Infectious Diseases, STI Outpatient Clinic, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands.
authors.forename: I K C W
authors.initials: IK
authors.lastname: Joore
authors.forename: Martijn Sebastiaan
authors.initials: MS
authors.lastname: van Rooijen
authors.forename: Maarten Franciscus
authors.initials: MF
authors.lastname: Schim van der Loeff
authors.forename: A J
authors.initials: AJ
authors.lastname: de Neeling
authors.forename: Alje
authors.initials: A
authors.lastname: van Dam
authors.forename: Henry J C
authors.initials: HJ
authors.lastname: de Vries