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  IAS 2019: Conference on HIV Pathogenesis
Treatment and Prevention
Mexico City
July 21-24 2019
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High STI Prevalence in German MSM,
But Low Rates of HIV, HCV, HBV

  10th IAS Conference on HIV Science (IAS 2019), July 21-24, 2019, Mexico City
Mark Mascolini
Among men who have sex with men (MSM) at risk for HIV infection at 10 sites in 7 German cities, 10% or more had gonorrhea, chlamydia, or Mycoplasma genitalium [1]. But fewer than 0.5% had HIV or hepatitis virus infection.
BRAHMS Study investigators noted that the new HIV diagnosis rate has been dropping in Germany. Because little is known about the impact of recent innovations like PrEP on rates of sexually transmitted infections (STIs), they analyzed trends in STIs and HIV in this prospective cohort of MSM at risk for HIV.
The BRAHMS cohort includes HIV-negative MSM between 18 and 45 years old with at least one of 3 risk behaviors: condomless anal sex with at least 2 HIV-positive or status-unknown male partners in the past 24 weeks, or a documented history of syphilis in the past 24 weeks, or a documented history of rectal gonorrhea or chlamydia in the past 24 weeks.
Health workers screen BRAHMS participants every 3 months for HIV, HAV, HBV, HCV, gonorrhea, syphilis, Chlamydia trachomatis, Mycoplasma genitalium, and other STIs. Diagnoses rely on blood, urine, anal swab, and oropharyngeal swab samples. MSM complete a sex behaviour questionnaire at each screening visit.
Among 1040 study participants, 51% were 26 to 35 years old, 13% were younger, and the rest older. Two thirds were born in Germany, and most the rest came from the United States or Western Europe. While 36% had a history of gonorrhoea, 24% had previous chlamydia, 18% syphilis, and 14% mycoplasma infection. This analysis began just as PrEP became widely available in Germany. When men enrolled in BRAHMS, 45% already used PrEP, while 18% started PrEP after risk counselling and 37% did not use PrEP.
The most prevalent current STIs were Mycoplasma genitalium in 18.8%, chlamydia in 12.7%, gonorrhea in 9.9%, and syphilis in 4.3%. Only 0.4% of men had HIV and 0.4% HCV, and no one had hepatitis A or B. One quarter of men tested positive for more than 1 STI, and more than 60% of STI cases caused no symptoms (including chlamydia, Mycoplasma genitalium, gonorrhea, and syphilis).
Prevalence of individual STIs did not differ between men who started PrEP before entering BRAHMS and those who never took PrEP. But the researchers noted that only incidence data will determine whether PrEP affects STI risk in this population. All prevalent HIV infections involved men who did not use PrEP.
1. Streeck H, Janssen K, Crowell TA, et al. Prospective, multicenter study to assess point prevalence, incidence and recurrence of sexually transmitted infections in men who have sex with men in Germany: BRAHMS study. 10th IAS Conference on HIV Science (IAS 2019), July 21-24, 2019, Mexico City. Abstract TUPDC0106.