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To B, Chai N, Fitzpatrick C, Richardson D. Factors associated with Cryptosporidium in men who have sex with men: A systematic review. Int J STD AIDS 2024; 35:668-674. [PMID: 38671340 DOI: 10.1177/09564624241249203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
BACKGROUND Cryptosporidium parasites are an important cause of diarrhoea globally and sexual transmission may occur in men who have sex with men (MSM). We aimed to systematically review the literature to explore any factors associated with transmission of Cryptosporidium in MSM to provide insight for future guidelines and public health strategies. METHODS We searched MEDLINE, Embase, CINAHL and Web of Science for manuscripts published up to July 2023. A primary author conducted an initial screen of abstracts and full text eligibility, and risk of bias was assessed independently by two authors using the Joanna Briggs Institute critical appraisal tools. We used the nine-point synthesis without meta-analysis method to synthesise narrative data. The review was registered on PROSPERO (CRD42023374279). RESULTS Six manuscripts were included in the final review from the USA (n = 3), Europe (n = 1) and Australia (n = 2) and were case series (n = 2), cross sectional (n = 2) and case control studies (n = 2) published between 1984 and 2021 and overall there were 1582 cases of Cryptosporidium in MSM. We identified demographic factors (living with HIV, younger age [<30 years old], geographical areas [Southern Europe v Northern Europe], previous Treponema pallidum, previous Entamoeba histolytica) and behavioural factors (recreational drug use, higher number of sexual partners and MSM attending sex on premises venues with spa/sauna) associated with Cryptosporidium in MSM. CONCLUSIONS Despite a small number of manuscripts in this review, we identified demographic and behavioural factors associated with Cryptosporidium in MSM. These data will provide insight for public health interventions for future outbreaks of Cryptosporidium in MSM.
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Affiliation(s)
- Benjaman To
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Ningyu Chai
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Colin Fitzpatrick
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom of Great Britain and Northern Ireland
- Brighton and Sussex Medical School
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Richardson D, Savary-Trathen A, Fitzpatrick C, Williams D. Estimated prevalence and associations of sexually transmissible bacterial enteric pathogens in asymptomatic men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect 2024:sextrans-2024-056183. [PMID: 38902026 DOI: 10.1136/sextrans-2024-056183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/09/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE The reservoir of sexually transmissible bacterial enteric pathogens in asymptomatic men who have sex with men (MSM) may impact future outbreaks, and the evolution of antimicrobial resistance. We aimed to estimate the pooled prevalence and explore any factors associated with Shigella spp, Campylobacter spp, diarrhoeagenic Escherichia coli and Salmonella spp in asymptomatic MSM using the random effects model. METHODS We searched Embase, MEDLINE, CINAHL and Web of Science Core Collections for manuscripts published up to February 2024. One author screened citations and abstracts; two authors independently conducted a full-text review. We included manuscripts which measured the prevalence of Shigella spp, Campylobacter spp, diarrhoeagenic E. coli and Salmonella spp in asymptomatic MSM. Quality and risk of bias was assessed independently by two authors using the Joanna Briggs Institute critical appraisal tools. We calculated pooled prevalence and CIs using the random effects model. RESULTS Six manuscripts were included in the final review. The manuscripts were from Australia (n=2), the UK (n=2), the Netherlands (n=1) and the USA (n=1) and included data from 3766 asymptomatic MSM tested for bacterial enteric pathogens. The prevalence of Shigella spp was 1.1% (95% CI 0.7% to 1.7%), Campylobacter spp 1.9% (95% CI 1.5% to 2.5%), diarrhoeagenic E. coli 3.8% (95% CI 2.1% to 6.7%) and Salmonella spp 0.3% (95% CI 0.1% to 0.6%). Two manuscripts demonstrated that the detection of bacterial enteric pathogen was more frequent in asymptomatic MSM using HIV-pre-exposure prophylaxis (PrEP), living with HIV, reporting <5 new sexual partners in the past 3 months, reporting insertive oral-anal sex and group sex compared with MSM testing negative. CONCLUSION Despite a small number of manuscripts, this review has estimated the pooled prevalence, and highlighted some possible associations with sexually transmissible bacterial enteric pathogens in asymptomatic MSM, which can inform future clinical guidelines, public health control strategies and research to increase our understanding of transmission and the evolution of antimicrobial resistance. PROSPERO REGISTRATION NUMBER CRD42024518700.
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Affiliation(s)
- Daniel Richardson
- Sexual Health & HIV medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Amber Savary-Trathen
- Sexual Health & HIV medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Colin Fitzpatrick
- Sexual Health & HIV medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Deborah Williams
- Sexual Health & HIV medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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3
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Miller TI, Banning S, Lieberman JA. Risk factors and provider awareness of sexually transmitted enteric pathogens among men who have sex with men. Microbiol Spectr 2024; 12:e0357723. [PMID: 38391230 PMCID: PMC10986602 DOI: 10.1128/spectrum.03577-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Sexual transmission of enteric pathogens among men who have sex with men (MSM) is well documented, although whether providers are cognizant of this risk when MSM patients present with gastrointestinal symptoms has not been studied. Over 34 months at a major tertiary metropolitan medical system, this study retrospectively analyzed 436 BioFire FilmArray Gastrointestinal results from 361 patients documented as MSM. An extensive chart review was performed, including specific sexual behaviors, socioeconomic risk factors, and whether providers charted a sexual history when a patient presented for care. Overall BioFire positivity rate was 62% with no significant difference in positivity between persons living with HIV and those without. Patients charted as sexually active had a significantly increased odds ratio (OR) of a positive result compared to those who were not. Anilingus had the highest OR. Providers charted any type of sexual history in 40.6% of cases, and HIV/infectious disease providers were significantly more likely to do this compared to other subspecialties. Sexual transmission of enteric pathogens within MSM is ongoing, and patients are at risk regardless of living with HIV. Not all sexual behaviors have the same associated risk, highlighting opportunities to decrease transmission. Increased provider vigilance and better patient education on sexual transmission of enteric pathogens are needed to reduce the disease burden. IMPORTANCE Our work adds several key findings to the growing body of literature describing the epidemiology of enteric pathogens as sexually transmitted infections among men who have sex with men (MSM). We analyzed clinical test results, housing status, provider awareness, sexual behaviors, and symptoms for 361 patients. We found that any sexual activity was associated with an increased risk of diarrheal pathogen detection, whereas being unhoused was not a risk factor. These findings suggest separate transmission networks between unhoused persons, who are also at risk of infectious diarrhea, and MSM. Moreover, our study suggested low awareness among patient-facing clinicians that diarrheal pathogens can be sexually transmitted. Together, our findings indicate an important opportunity to disrupt transmission cycles by educating clinicians on how to assess and counsel MSM patients.
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Affiliation(s)
- Timothy Isaac Miller
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Stephanie Banning
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joshua A. Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Tsai CS, Wang JL, Liao YS, Fukushige M, Chiou CS, Ko WC. Shigellosis in Taiwan: An old enteric pathogen with changing epidemiology and increasing antimicrobial resistance. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023:S1684-1182(23)00206-2. [PMID: 37951802 DOI: 10.1016/j.jmii.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/07/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Abstract
While the incidence of shigellosis has decreased in developed nations due to improved living conditions and healthcare systems, it remains prevalent in economically developing regions. In recent years, a resurgence of shigellosis has been observed in the United States, Europe, and Taiwan, primarily among men having sex with men and people living with human immunodeficiency virus, along with a rise in antimicrobial resistance. This study aims to review the historical epidemiological trends and drug resistance in shigellosis, with a focus on Taiwan. A comprehensive search was conducted using various databases and sources, including non-English literature in Japanese and Chinese. In developed countries, Shigella sonnei and Shigella flexneri are the most common species, while Shigella dysenteriae infections are sporadic. In Taiwan, the classification and prevalence of Shigella species have evolved over time, with S. flexneri and S. sonnei being the predominant strains. Fluoroquinolone resistance and azithromycin non-susceptibility are the ongoing threat. In conclusion, shigellosis remains a significant global health concern, with recent increases in certain populations and antimicrobial resistance. Further research is necessary to understand the clinical significance and risk factors associated with asymptomatic carriers and to assess the impact of behavioral modifications and interventions in high-risk populations.
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Affiliation(s)
- Chin-Shiang Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Shu Liao
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan
| | - Mizuho Fukushige
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Chien-Shun Chiou
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan.
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Richardson D, Pakianathan M, Ewens M, Mitchell H, Mohammed H, Wiseman E, Tweed M, Nichols K, Rawdah W, Cooper R, Macrowan R, Irish M, Evans A, Godbole G. British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023. Int J STD AIDS 2023:9564624231168217. [PMID: 37247427 DOI: 10.1177/09564624231168217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This is the first British Association of Sexual Health and HIV (BASHH) national guideline for the management of sexually transmitted enteric infections (STEI). This guideline is primarily aimed for level 3 sexual health clinics; however, it may also be applicable to other settings such as primary care or other hospital departments where individuals with STEI may present. This guideline makes recommendations on testing, management, partner notification and public health control of STEI.
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Affiliation(s)
- Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | | | | | | | | | | | | | | | - Waseem Rawdah
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Richard Cooper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Amy Evans
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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6
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Tsai CS, Chen PL, Lee NY, Tsai HP, Huang SH, Chen SY, Tang YW, Lin YC, Tsai PF, Mao LW, Su SL, Wang JL, Ko WC. Characteristics of rectal chlamydia among men who have sex with men in southern Taiwan, 2020-2022: An emerging threat of rectal lymphogranuloma venereum L2b. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:408-415. [PMID: 36682913 DOI: 10.1016/j.jmii.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/13/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prevalence of rectal chlamydia among men who have sex with men (MSM) without human deficiency virus infection (non-HIV) remains uncertain in Taiwan, and rectal lymphogranuloma venereum (LGV) among MSM has never been reported in the Far East. MATERIAL AND METHODS From January 2020 to April 2022, MSM coming for anonymous voluntary counseling and testing, for pre-exposure prophylaxis, and for antiretroviral therapy were enrolled. All participants submitted his fecal samples and completed a QR-code questionnaire. Medical records of those who took regular medical visits for HIV were recorded. Multiplex polymerase chain reaction (PCR) was performed for all fecal samples, and ompA gene sequencing was therefore performed for each Chlamydia-positive fecal sample. RESULTS Among 341 MSM during 2020-2022 in southern Taiwan, 21 (6.2%) had rectal chlamydia infection. Risk factors of rectal chlamydia included co-infection with rectal gonorrhea (adjusted odds ratio [AOR] 6.78, 95% confidence interval [CI] 1.44-31.91, P = 0.015) and multiple sexual partners (AOR 1.373, 95% CI 1.002-1.882, P = 0.048). Further ompA gene sequencing from 19 Chlamydia-positive fecal samples revealed that the prevalent genotypes or genovariants were Da (26.3%) and L2b (26.3%), followed by B (21.1%), J (14.3%), and G (9.5%). All cases of rectal LGV genovariant L2b presented as acute proctitis with diarrhea, anal pain, or discharge and were treated successfully with prolonged treatment of doxycycline. CONCLUSIONS Rectal gonorrhea and multiple sexual partners are risk factors for rectal chlamydia. Clinicians in Taiwan should be aware of the emerging threat of rectal LGV among MSM with acute proctitis.
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Affiliation(s)
- Chin-Shiang Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Lin Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huey-Pin Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Szu-Ying Chen
- Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Wen Tang
- Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Chun Lin
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Fang Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lin-Wen Mao
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Li Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Osman M, Kassem II, Dabboussi F, Cummings KJ, Hamze M. The indelible toll of enteric pathogens: Prevalence, clinical characterization, and seasonal trends in patients with acute community-acquired diarrhea in disenfranchised communities. PLoS One 2023; 18:e0282844. [PMID: 36913372 PMCID: PMC10010529 DOI: 10.1371/journal.pone.0282844] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND There is little information on the epidemiology of enteric pathogens in Lebanon, a low- and middle-income country that suffers from a myriad of public health challenges. To address this knowledge gap, we aimed to assess the prevalence of enteric pathogens, identify risk factors and seasonal variations, and describe associations between pathogens among diarrheic patients in the Lebanese community. METHODOLOGY AND PRINCIPAL FINDINGS A multicenter cross-sectional community-based study was conducted in the north of Lebanon. Stool samples were collected from 360 outpatients suffering from acute diarrhea. Based on fecal examination using the BioFire® FilmArray® Gastrointestinal Panel assay, the overall prevalence of enteric infections was 86.1%. Enteroaggregative Escherichia coli (EAEC) was the most frequently identified (41.7%), followed by enteropathogenic E. coli (EPEC) (40.8%) and rotavirus A (27.5%). Notably, two cases of Vibrio cholerae were identified, while Cryptosporidium spp. (6.9%) was the most common parasitic agent. Overall, 27.7% (86/310) of the cases were single infections, and the majority, 73.3% (224/310), were mixed infections. Multivariable logistic regression models showed that enterotoxigenic E. coli (ETEC) and rotavirus A infections were significantly more likely to occur in the fall and winter compared to the summer. Rotavirus A infections significantly decreased with age but increased in patients living in rural areas or suffering from vomiting. We identified strong associations in the co-occurrence of EAEC, EPEC, and ETEC infections and a higher percentage of rotavirus A and norovirus GI/GII infections among EAEC-positive cases. CONCLUSIONS Several of the enteric pathogens reported in this study are not routinely tested in Lebanese clinical laboratories. However, anecdotal evidence suggests that diarrheal diseases are on the rise due to widespread pollution and the deterioration of the economy. Therefore, this study is of paramount importance to identify circulating etiologic agents and prioritize dwindling resources to control them and limit outbreaks in the future.
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Affiliation(s)
- Marwan Osman
- Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY, United States of America
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States of America
| | - Issmat I. Kassem
- Center for Food Safety and Department of Food Science and Technology, University of Georgia, Griffin, GA, United States of America
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Kevin J. Cummings
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States of America
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
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8
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Siddiq M, O'Flanagan H, Richardson D, Llewellyn CD. Factors associated with sexually transmitted shigella in men who have sex with men: a systematic review. Sex Transm Infect 2023; 99:58-63. [PMID: 36283806 DOI: 10.1136/sextrans-2022-055583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Outbreaks of sexually transmitted shigella have been reported in men who have sex with men (MSM) since the 1970s and present a major public health issue. Understanding the factors associated with the sexual transmission of shigella may inform future control strategies. METHODS We systematically searched four bibliographical databases (January 2000-February 2022) for manuscripts in English. We used a two-stage process to assess eligibility: the primary author conducted an initial screen and then three authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts that included MSM diagnosed with sexually transmitted shigella where specific factors associated with transmission were identified. RESULTS Thirteen manuscripts met the inclusion criteria that included 547 individuals. Sexually transmitted shigella in MSM was associated with: residing in a capital city/urban region, living with HIV (including engaging in seroadaptive sexual behaviour, having a low CD4 count, having a HIV viral load >100 000 and not engaging with HIV care), using HIV pre-exposure prophylaxis, use of geospatial mobile phone applications to meet sexual partners, visiting sex on premises venues, chemsex and recreational drug use, sexual behaviour (including multiple non-regular sexual partners and oral-anal sexual contact) and concomitant STIs. CONCLUSION We have highlighted some important risk behaviours and factors that are associated with sexually transmitted shigella in MSM that can be used to target future shigella control interventions.
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Affiliation(s)
| | | | - Daniel Richardson
- Brighton and Sussex Medical School, Brighton, UK .,Department of Sexual Health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Carrie D Llewellyn
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton, Brighton and Hove, UK
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9
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Chen MY, Williamson DA. Sexually acquired enteric infections among men who have sex with men. THE LANCET. INFECTIOUS DISEASES 2023; 23:644-645. [PMID: 36731482 DOI: 10.1016/s1473-3099(22)00813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3053, Australia; Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Deborah A Williamson
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Melbourne, VIC, Australia; Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
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10
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Mitchell HD, Whitlock G, Zdravkov J, Olsson J, Silalang P, Bardsley M, Blomquist PB, Jenkins C, Thomson NR, Field N, Hughes G. Prevalence and risk factors of bacterial enteric pathogens in men who have sex with men: A cross-sectional study at the UK's largest sexual health service. J Infect 2023; 86:33-40. [PMID: 36343788 PMCID: PMC10564623 DOI: 10.1016/j.jinf.2022.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/05/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Outbreaks of bacterial enteric pathogens (BEPs) in men who have sex with men (MSM) associated with antimicrobial resistance are a public health concern. We investigated the prevalence and risk factors of BEPs in MSM to inform infection control. METHODS We conducted a cross-sectional study at a London sexual health clinic between 20/12/2017 and 06/02/2018. Residual rectal swabs from MSM attending for sexually transmitted infection (STI) testing were anonymously tested for a range of BEPs using real-time PCR. A sub-set of samples were tested for the mphA gene (a marker of azithromycin resistance). Results were linked to electronic health records. RESULTS BEPs were detected in 207 of 2116 participants, giving an overall prevalence of 9.8% (95% CI 8.5%-11.1%) ranging from 0.8% (0.4%-1.2%) for Shigella to 4.9% (4.0%-5.9%) for Enteroaggregative E. coli. MSM with BEPs were more likely to have a history of bacterial STIs (p = 0.010), to report more sexual partners (p<0.001), and among HIV-negative MSM, to report current HIV pre-exposure prophylaxis use (p<0.001). Gastrointestinal symptoms were rare (1.7%) and not associated with BEPs. 41.3% of MSM with BEPs and 14.1% of those without BEPs carried mphA (p<0.001). Among the former, this was associated with a history of bacterial STIs (51.5% vs 31.1%, p = 0.003). CONCLUSIONS One in ten MSM had a BEP detected and most did not report symptoms. MphA carriage was common, particularly among those with BEPs. Bacterial STI treatment might contribute to selection of resistant gut organisms, emphasising the need for better antimicrobial stewardship.
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Affiliation(s)
- Holly D Mitchell
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK.
| | - Gary Whitlock
- 56 Dean Street, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, W1D 6AQ, UK
| | - Jey Zdravkov
- 56 Dean Street, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, W1D 6AQ, UK
| | - Jenny Olsson
- 56 Dean Street, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, W1D 6AQ, UK; Imperial College School of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Panida Silalang
- Clinical and Public Health Group, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Megan Bardsley
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK; Clinical and Public Health Group, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Paula B Blomquist
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK; Clinical and Public Health Group, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Claire Jenkins
- Clinical and Public Health Group, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections at University of Liverpool, UK
| | - Nicholas R Thomson
- Parasites and Microbes, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, CB10 1SA, UK; Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK
| | - Gwenda Hughes
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK; Clinical and Public Health Group, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
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Charles H, Prochazka M, Thorley K, Crewdson A, Greig DR, Jenkins C, Painset A, Fifer H, Browning L, Cabrey P, Smith R, Richardson D, Waters L, Sinka K, Godbole G, Corkin H, Abrahams A, LeBlond H, Lo J, Holgate A, Saunders J, Plahe G, Vusirikala A, Green F, King M, Tewolde R, Jajja A. Outbreak of sexually transmitted, extensively drug-resistant Shigella sonnei in the UK, 2021–22: a descriptive epidemiological study. THE LANCET INFECTIOUS DISEASES 2022; 22:1503-1510. [DOI: 10.1016/s1473-3099(22)00370-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 12/23/2022]
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12
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Lappan R, Jirapanjawat T, Williamson DA, Lange S, Chown SL, Greening C. Simultaneous detection of multiple pathogens with the TaqMan Array Card. MethodsX 2022; 9:101707. [PMID: 35518918 PMCID: PMC9062751 DOI: 10.1016/j.mex.2022.101707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/12/2022] [Indexed: 02/07/2023] Open
Abstract
Quantitative polymerase chain reaction (qPCR) is a gold standard method for the detection and quantification of pathogenic organisms. Standard qPCR is inexpensive, sensitive and highly specific to the pathogen of interest. While qPCR assays can be multiplexed to allow the detection of multiple organisms in one reaction, it is prohibitively labour intensive to screen large numbers of samples for several pathogens at the same time. The TaqMan Array Card (TAC) is a cost-effective and accurate technique that expands the number of assays that can be simultaneously performed on a sample, with no increase in set-up time and only small reductions in sensitivity. This approach is highly beneficial in settings where there is a need to monitor a large panel of pathogens. We illustrate the application of TAC to the monitoring of gastrointestinal pathogens, which span viral, bacterial, protist and helminth taxa. This protocol outlines the laboratory set-up of a TaqMan Array Card, and some recommended data processing steps to aid in accurate interpretation of the results. A video protocol is additionally provided to assist in the use of the technique.•The TAC is designed primarily for gene expression assays, but has recently been utilised in several studies for pathogen detection in human clinical samples.•We expand the use of TAC for pathogen detection across human, animal and environmental sample types, and have developed a protocol and guidelines for the processing and interpretation of results that circumvents issues with the automated outputs.•This technique is applicable to pathogen or organism detection in any context, if quality nucleic acid extracts can be obtained from the sample type of interest.
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Affiliation(s)
- Rachael Lappan
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Thanavit Jirapanjawat
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Deborah A Williamson
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Sigrid Lange
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Steven L Chown
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
| | - Chris Greening
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
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13
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Purpura L, Zucker J, LaSota E, Lopez M, Spicehandler R, Carnevale C, Perez E, Richards P, Chang J, Cohall A, Uhlemann AC, Whittier S, Sobieszczyk ME, Green DA. Prevalence of Gastrointestinal Pathogens Detected by Multiplex Polymerase Chain Reaction in a Prospective Cohort of Men Who Have Sex With Men Taking Human Immunodeficiency Virus Preexposure Prophylaxis-New York City, 2019-2020. Open Forum Infect Dis 2021; 8:ofab411. [PMID: 34430675 PMCID: PMC8379716 DOI: 10.1093/ofid/ofab411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Multiplex polymerase chain reaction testing for gastrointestinal pathogens was performed on a longitudinal cohort of 110 men who have sex with men taking human immunodeficiency virus preexposure prophylaxis. At least 1 pathogen was detected among 50 (45%) participants, with some participants testing positive for the same pathogen on multiple consecutive visits over a period of months.
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Affiliation(s)
- Lawrence Purpura
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.,ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elijah LaSota
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Mabel Lopez
- Clinical Microbiology, Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca Spicehandler
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Edward Perez
- New York Presbyterian-Columbia Hospital, New York, New York, USA
| | - Paul Richards
- New York Presbyterian-Columbia Hospital, New York, New York, USA
| | - Jennifer Chang
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Al Cohall
- New York Presbyterian-Columbia Hospital, New York, New York, USA
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Susan Whittier
- Clinical Microbiology, Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | - Magdalena E Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel A Green
- Clinical Microbiology, Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
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14
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Brief Report: Group Sex Among Men Who Have Sex With Men in the Era of PrEP: A Cross-Sectional Study. J Acquir Immune Defic Syndr 2021; 86:e23-e27. [PMID: 33093332 DOI: 10.1097/qai.0000000000002550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Group sex has been commonly reported among gay and bisexual men who have sex with men (GBMSM); however, there are limited studies on the factors associated with participating in group sex. SETTING A cross-sectional study among GBMSM attending a sexual health clinic in Melbourne, Australia. METHODS Univariable and multivariable logistic regression were performed to examine the association between GBMSM participating in group sex in the previous 3 months and their demographic characteristics, including age, pre-exposure prophylaxis (PrEP) use, HIV status, any STI (gonorrhea, chlamydia, syphilis) diagnosis on the day, and method of seeking partners. RESULTS There were 357 GBMSM who participated in the survey and their mean age was 32.9 years (SD = 10.9). Almost a third (n = 115; 32.2%) had participated in group sex in the previous 3 months. GBMSM who sought sex partners at sex on premises venues (SOPVs) [aOR 5.83; 95% confidence interval (CI): 3.23 to 10.53] had the highest odds of group sex participation after adjusting for other potential confounders. Compared with GBMSM not living with HIV and not taking PrEP, GBMSM taking PrEP had higher odds of group sex participation (aOR 2.09; 95% CI: 1.05 to 4.15), but GBMSM living with HIV did not (aOR 0.93; 95% CI: 0.23 to 3.68).Recent group sex participation was not associated with being diagnosed with any STI (chlamydia, syphilis, or gonorrhea) on the day in the adjusted analyses. CONCLUSION PrEP users and MSM attending SOPVs are more likely to participate in group sex. SOPV could be important venues for future public health campaigns.
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15
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Phillips TR, Tabesh M, Fairley CK, Maddaford K, Pasricha S, Wigan R, De Petra V, Williamson DA, Chow EPF. A comparison of cotton-tipped and nylon flocked swabs for culture of Neisseria gonorrhoeae from oropharyngeal samples. Diagn Microbiol Infect Dis 2021; 101:115455. [PMID: 34256252 DOI: 10.1016/j.diagmicrobio.2021.115455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/19/2022]
Abstract
Our aim was to determine if there was a difference in culture positivity for oropharyngeal gonorrhoea when sampling using a nylon-flocked versus cotton-tipped swab. We collected FLOQSwabs and cotton-tipped swabs from individuals aged ≥ 18 years who had untreated oropharyngeal gonorrhoea detected by NAAT between November 2019-June 2020.Of 78 participants, 32 (41.0%) were culture-positive for N. gonorrhoeae from either swab. Of these 32, 29 (90.6%, 95%CI: 75.0%-98.0%) were positive on both swabs, one (3.1%, 95%CI: 0.0%-16.2%) tested positive on FLOQSwab only and two (6.2%, 95%CI: 0.1%-20.8%) tested positive on cotton-tipped swabs only. There was moderate agreement between the swabs in the amount of bacterial growth (Cohen's Kappa (k)=0.745; 95%CI: 0.622-0.868, p<0.001). Our results showed that the proportion of positive results was comparable using the FLOQSwabs versus the cotton-tipped swabs for oropharyngeal gonorrhoea culture.
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Affiliation(s)
- Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Marjan Tabesh
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Shivani Pasricha
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Vesna De Petra
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity at The University of Melbourne, Melbourne, Victoria, Australia; Department of Microbiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
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16
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Vodstrcil LA, Fairley CK, Williamson DA, Bradshaw CS, Chen MY, Chow EPF. Immunity to hepatitis A among men who have sex with men attending a large sexual health clinic in Melbourne, Australia, 2012-2018. Sex Transm Infect 2020; 96:265-270. [PMID: 32169881 DOI: 10.1136/sextrans-2019-054327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/24/2020] [Accepted: 02/19/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Outbreaks of hepatitis A are being reported more commonly among men who have sex with men (MSM) globally. Australia has also reported a sharp increase in the number of cases of hepatitis A in 2017. This study aimed to determine the level of immunity to hepatitis A among MSM attending a large urban sexual health clinic in Victoria in the lead up to recent outbreak. METHODS This was a retrospective audit of serological testing data from first-time MSM attendees at Melbourne Sexual Health Centre (MSHC) in Australia from 1 January 2012 to 31 December 2018. We determined the proportion of MSM who were tested and who had serological detection of hepatitis A IgG, stratified by age and calendar year. We used univariable and multivariable logistic regression to investigate factors associated with testing for and detection of hepatitis A IgG. RESULTS There were 16 609 first-time MSM attendees at MSHC over the 7-year period, of which 9718 (59%, 95% CI 58% to 60%) were tested for hepatitis A IgG. There was a 2% annual increase in the proportion of men tested (from 60% in 2012 to 69% in 2018; OR=1.02, 95% CI 1.00 to 1.03, p=0.025). Men born outside of Australia/New Zealand, and younger men <30 years had higher odds of being tested. Of those tested, 44% (n=4304, 95% CI 43% to 45%) had hepatitis A IgG detected at their first visit, with no change over time (OR=1.01, 95% CI 0.99 to 1.03, p=0.210). Detection of hepatitis A IgG was associated with being aged 30 years or older (adjusted OR=2.06, 95% CI 1.89 to 2.24, p<0.001) or being born overseas versus Australia/New Zealand (AOR=1.21, 95% CI 1.11 to 1.31, p<0.001). CONCLUSION Hepatitis A immunity among MSM remains below the estimated 70% required to prevent outbreaks. Measures including increased testing and higher vaccination coverage are needed to prevent outbreaks and to limit the number of cases and deaths.
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Affiliation(s)
- Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia .,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Deborah A Williamson
- Melbourne Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Doherty Applied Microbial Genomics, Department of Microbiology & Immunology, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
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