The sexual health of gay and bisexual men in England and Wales deteriorated rapidly between 1997 and 2002, according to an examination of recent trends in diagnoses of HIV and other sexually transmitted infections (STIs) by the Communicable Disease Surveillance Centre (CDSC) that was recently published in the the online edition of Sexually Transmitted Infections. In addition, compared with heterosexual men, in 2002, gay and bisexual men were twice as likely to be diagnosed with genital warts, herpes or chlamydia, eight-times as likely to be diagnosed with gonorrhoea, and greater than 50-times more likely to be diagnosed with HIV or syphilis.
In order to examine trends in the rates of diagnoses of HIV and other STIs, researchers from the CDSC combined data they received between 1997 and 2002 regarding new diagnoses of HIV; the annual Survey of Prevalent HIV Infections Diagnosed (SOPHID); and statutory quarterly aggregate statistical returns from GUM clinics (KC60) regarding diagnoses of acute gonorrhoea, infectious syphilis, genital chlamydia, and first attacks of genital warts and herpes. They estimated the populations of gay and bisexual men by using data from the second UK National Survey of Sexual Attitudes and Lifestyles (Natal 2000), and then analysed all the data to examine changes over time in HIV and STI rates per 100,000 gay and bisexual men.
They found that between 1997 and 2002, the rate of diagnosis of all major acute STIs increased substantially in gay and bisexual men in England and Wales. Gonorrhoea remained the most common STI diagnosed in gay and bisexual men in England and Wales, followed by genital warts, HIV and chlamydia, although HIV was the second most common STI diagnosed amongst gay and bisexual men in London.
The biggest increases were in the rates of diagnoses of bacterial STIs, with a doubling in gonorrhoea diagnoses between 1999 and 2001, from 661 to 1271 per 100,000 (p<0.001); and a doubling of chlamydia diagnoses from 226 to 504 per 100,000 (p<0.001) in the same period. Although these rates declined in 2002 to 1210 and 524 per 100,000, respectively, rates are still higher than in 1999, and, add the researchers, “to date, this decline appear to be restricted to men aged over 25 in London.”
Viral STI rate increases between 1997 and 2002 were not as dramatic as the bacterial STIs, but nevertheless worrying. New diagnoses of genital warts increased from 536 per 100,000 to 727 per 100,000 (p<0.001) and first-time genital herpes diagnoses increased from 121 per 100,000 to 176 per 100,000 (p<0.001). Rates of diagnoses of HIV infection increased from 478 to 601 per 100,000 (p<0.001). The authors point out that as the prevalence of HIV increases amongst gay and bisexual men, HIV-negative gay and bisexual men “will have a much higher probability of having sex with a man with HIV than any other acute STI,” since, unlike the other STIs, HIV infection is lifelong and incurable.
The researchers also examined rates of diagnosis of HIV and other STIs within and outside London, and found that although rates were lower outside London, increases were of a similar magnitude.
Finally, the researchers put the sexual health of gay and bisexual into perspective by comparing rates of HIV and STI diagnoses in 2002 with heterosexual men aged 16-44. In all cases, gay and bisexual men had poorer sexual health. For heterosexual men, rates of gonorrhoea were 140 per 100,000, compared with 1210 per 100,000 for gay and bisexual men. For genital warts, the rates were 337 versus 727 per 100,00; genital chlamydia, 341 versus 524 per 100,000; infectious syphilis, 4 versus 225 per 100,000; genital herpes, 63 versus 176 per 100,000; and for new HIV diagnoses, the rates were 13 versus 601 per 100,000, respectively.
The authors conclude by saying that “it is perhaps too early to hope that the downward trend in the incidence of gonorrhoea in London will continue and extend to areas outside London. However, whatever the trajectory, the determinants of such temporal trends merit further investigation to determine the relative contributions of behavioural modifications (sexual or health service use), GUM access and service provision, and prevention interventions.”