Evidence of changing sexual behaviours and clinical attendance patterns, alongside increasing diagnoses of STIs in MSM and TPSM.
Louis MacGregor, Nathan Speare, Jane Nicholls, Lindsey Harryman, Jeremy Horwood, Joanna May Kesten, Ava Lorenc, Patrick Horner, Natalie Lois Edelman, Peter Muir, Paul North, Mark Gompels, Katy M E Turner
Author Information
Louis MacGregor: Department of Population Health Sciences, University of Bristol, Bristol, UK louis.macgregor@bristol.ac.uk. ORCID
Nathan Speare: Bristol Sexual Health Centre, Bristol, UK.
Jane Nicholls: Department of Population Health Sciences, University of Bristol, Bristol, UK.
Lindsey Harryman: Bristol Sexual Health Centre, Bristol, UK.
Jeremy Horwood: Department of Population Health Sciences, University of Bristol, Bristol, UK.
Joanna May Kesten: Department of Population Health Sciences, University of Bristol, Bristol, UK.
Ava Lorenc: Department of Population Health Sciences, University of Bristol, Bristol, UK.
Patrick Horner: Department of Population Health Sciences, University of Bristol, Bristol, UK.
Natalie Lois Edelman: School of Health Sciences, University of Brighton, Brighton, UK. ORCID
Peter Muir: National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK.
Paul North: Public Health England South Region, Bristol, UK.
Mark Gompels: North Bristol NHS Trust, Westbury on Trym, Bristol, UK.
Katy M E Turner: Department of Population Health Sciences, University of Bristol, Bristol, UK. ORCID
BACKGROUND: Due to rising numbers of STI diagnosis and increasing prevalence of antimicrobial resistance, we explored trends in STI testing frequency and diagnoses, alongside sexual decision making and attitudes concerning condom use and HIV pre-exposure prophylaxis (PrEP) at a large urban UK sexual health clinic. METHODS: We examined 66 528 electronic patient records covering 40 321 attendees between 2016 and 2019, 3977 of whom were men who have sex with men or trans persons who have sex with men (MSM/TPSM). We also explored responses from MSM/TPSM attendees sent an electronic questionnaire between November 2018 and 2019 (n=1975) examining behaviours/attitudes towards PrEP. We measured trends in STI diagnoses and sexual behaviours including condomless anal intercourse (CAI), using linear and logistic regression analyses. RESULTS: Tests resulting in gonorrhoea, chlamydia or syphilis diagnoses increased among MSM/TPSM from 13.5% to 18.5% between 2016 and 2019 (p<0.001). The average MSM/TPSM STI testing frequency increased from 1.5/person/year to 2.1/person/year (p=0.017). Gay MSM/TPSM had the highest proportions of attendances resulting in diagnoses, increasing from 15.1% to 19.6% between 2016 and 2019 (p<0.001) compared with bisexual/other MSM/TPSM increasing from 6.9% to 14.5% (p<0.001), alongside smaller but significant increases in non-MSM/TPSM from 5.9% to 7.7% (p<0.001).The proportion of MSM/TPSM clinic attendees reporting CAI in the previous 3 months prior to at least one appointment in a given year increased significantly from 40.6% to 45.5% between 2016 and 2019 (p<0.0001) and average number of partners from 3.8 to 4.5 (p=0.002). Of 617 eligible questionnaire responses, 339/578 (58.7%) HIV-negative and 29/39 (74.4%) HIV-positive MSM/TPSM indicated they would be more likely to have CAI with someone on PrEP versus not on PrEP. 358/578 (61.9%) HIV-negative respondents said that PrEP use would make them more likely to have CAI with HIV-negative partners. CONCLUSION: Rising numbers of STI diagnoses among MSM/TPSM are not attributable to increased testing alone. Increased CAI and number of partners may be attributable to evolving sexual decision making among PrEP users and their partners. Proportionally, bisexual/other MSM/TPSM have the steepest increase in STI diagnoses.
