Asymptomatic rectal Neisseria gonorrhoeae detection linked to future HIV seroconversion

Among young adult sexual and gender minority patients assigned male at birth, the detection of asymptomatic rectal Neisseria gonorrhoeae may be a significant predictor of HIV seroconversion, according to study results published in Open Forum Infectious Diseases.

Researchers sourced data from a longitudinal cohort study to estimate the predictive value of rectal bacterial sexually transmitted infection detection for future HIV seroconversion. The study was performed between March 2018 and August 2022 and included young adult sexual and gender minority patients assigned male at birth residing in the Chicago, Illinois metropolitan area. There were 3 patient cohorts initially enrolled in 2007, 2011, and 2015 that were subsequently merged to create a single cohort for the analysis.

Study patients were examined at clinical visits every 6 months and provided self-collected rectal swab samples for rectal N gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium testing at each visit. Owing to the COVID-19 pandemic, no patient underwent rectal STI testing from March through August of 2020 or November 2020 through March 2021.

The final analysis comprised 1022 patients, of whom 41.5% were aged between 21 and 24 years, 87.6% identified as men, 33.2% were Black, 17.5% were on HIV pre-exposure prophylaxis, and 20% were positive for HIV infection. At the initial study visit, reactivity rates for rectal M genitalium, N gonorrhoeae, and C trachomatis were 20.8 (95% CI, 18.4- 23.5), 6.5 (95% CI, 5.0-8.2), and 8.4 (95% CI, 6.8-10.3) per 100 persons, respectively.

Among patients (n=305) who tested reactive for any rectal bacterial STI, 17.7% were infected with more than 1 bacterial STI pathogen. Of patients who tested reactive for M genitalium and nonreactive for N gonorrhoeae and C trachomatis, 2.5% reported painful bowel movements, 2.5% reported bleeding, and 1.3% reported rectal discharge. The researchers observed no significant differences in the prevalence of individual symptoms based on the pattern of bacterial STI results (P >.05).

In HIV-negative patients who attended at least 1 follow-up visit, the rate of HIV seroconversion was 2.8%. Overall, patients who tested reactive vs nonreactive to M genitalium, N gonorrhoeae, or C trachomatis exhibited higher rates of HIV seroconversion (1.9%, 4.6%, and 2.0% vs 0.7%, 0.8%, and 0.9%, respectively).

In a multivariate analysis that included adjustments for demographic characteristics and sexual risk behavior, significant predictors of HIV seroconversion were rectal N gonorrhoeae detection (adjusted odds ratio [aOR], 5.11; 95% CI, 1.20-21.77) and number of condomless anal sex partners within the past 6 months (aOR, 1.11; 95% CI, 1.00-1.23). Further multivariate analysis with the addition of generalized estimating equations indicated that the inclusion of a single binary rectal bacterial STI predictor rather than 3 individual predictors was significantly associated with HIV seroconversion (aOR, 3.37; 95% CI, 2.22-9.31).

Limitations of this study include the use of data captured from a community sample and disruptions in rectal sample collection due to the COVID-19 pandemic.

“These findings highlight the importance of asymptomatic screening for b[acterial]STIs and targeting biobehavioral intervention to prevent HIV infection among YSGM [young sexual gender minorities] with rectal bSTI agents detected,” the researchers concluded.

By Paul Basilio

References:

Baiers RA, Ryan DT, Clifford A, et al. Asymptomatic rectal bacterial pathogens show large prospective relationships with HIV incidence in a cohort of young sexual and gender minorities: implications for STI screening and HIV prevention. Open Forum Infect Dis. Published online August 5, 2024. doi:10.1093/ofid/ofae444