Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion

J Acquir Immune Defic Syndr. 2010 Apr 1;53(4):537-43. doi: 10.1097/QAI.0b013e3181c3ef29.


Introduction: HIV infection continues to disproportionately affect men who have sex with men (MSM). Identification of modifiable risk factors for HIV infection among MSM is critical for effective prevention.

Methods: We examined the relationship between number of prior rectal Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) infections and HIV seroconversion in a retrospective cohort of HIV-uninfected MSM diagnosed with a rectal infection. Number of rectal CT or GC infections in the prior 2 years was the primary exposure. Univariate and multivariate Cox proportional hazards models were used to estimate the association between prior rectal infections and HIV seroconversion.

Results: A total of 541 MSM were observed for a total of 1197.96 person-years. Overall, 27 (4.99%) of the MSM became infected with HIV, for an estimated annual incidence of 2.25% [95% confidence interval (CI): 1.49 to 3.26]. In multivariate analysis, an early syphilis diagnosis in the past 2 years (hazard ratio = 4.04, 95% CI: 1.19 to 13.79) and 2 prior CT or GC rectal infections in the past 2 years (hazard ratio = 8.85, 95% CI: 2.57 to 30.40) were associated with incident HIV.

Conclusions: Among MSM infected with rectal GC or CT, a history of 2 additional prior rectal infections was associated with an 8-fold increased risk of HIV infection. HIV-uninfected MSM with multiple rectal infections represent a population in need of innovative HIV-prevention interventions.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Chlamydia Infections / complications*
  • Chlamydia Infections / epidemiology*
  • Gonorrhea / complications*
  • Gonorrhea / epidemiology*
  • HIV Seropositivity / epidemiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Rectal Diseases / complications*
  • Rectal Diseases / epidemiology*
  • Rectal Diseases / microbiology
  • Retrospective Studies
  • Risk Factors
  • Young Adult