High incidence of rectal gonorrhea (GC) in trials of new biomedical preventatives for men who have sex with men (MSM) suggest a potential association between GC and human immunodeficiency virus (HIV). As such, Deborah Donnell, PhD, and colleagues applied a meta–regression analysis to examine the association between rectal GC and HIV and determine whether rectal GC can serve as a measure for HIV risk. Their analysis of MSM attending sexual health clinics (SHC) in England found that rectal GC rates increased substantially while HIV incidence rates decreased between 2011 and 2018.

In a report published in Sexually Transmitted Infections, the authors theorized that “HIV incidence likely decreased through expanded HIV testing, prompt antiretroviral treatment (ART) initiation and increased viral suppression in persons living with HIV, interventions that did not decrease rectal GC.” Thus, “Rectal GC may not be an ideal proxy for HIV incidence in trials, as HIV exposure risk is complex and context dependent, given effective HIV prevention interventions in MSM.”

The study used routine surveillance data of 541,056 HIV-negative MSM from repeat visits to SHCs to examine any population–level associations between HIV incidence and new diagnoses of rectal GC.

HIV incidence among the patients fell from 1.26 per 100 person-years (PYs) in 2011 to 0.28 per 100 PYs in 2018. In the same period, rectal GC rates increased from 3.5 per 100 PYs to 11.1 per 100 PYs. The researchers calculated that the HIV incidence rate decreased by 22.3% for each one percent increase in rectal GC (95% confidence interval [CI], –30.8 to –14.7, p < 0.001).

The report summarized that the association between HIV and rectal GC incidence was strongly negative, the opposite of what was suggested in prior meta–analyses and at–odds with what might be expected for infections with the same common exposure route. This finding was “quite consistent” across different regions with varying incidences of HIV.


Source: Sexually Transmitted Infections