With early and ongoing treatment, people diagnosed today with HIV can expect to live a near-normal lifespan. But to enjoy good health into old age, they need to look after their overall health and well-being – including their physical, mental and sexual health.
One health risk for gay men with HIV is other sexually transmitted infections (STIs), such as syphilis, chlamydia, and gonorrhea. Although there are treatments for bacterial STIs, being infected with HIV and another STI is very hard on the body:
- HIV may weaken the immune system making it harder to fight other STIs.
- Treatment for other STIs may be more complex when someone is already being treated for HIV, and the treatments may not work as effectively. There has also been a recent increase in treatment-resistant gonorrhea, which would be very bad news for someone with HIV.
- Syphilis affects the brain and may spread more quickly to the brain in people with HIV.
- Infections with other STIs, particularly syphilis, may cause increases in HIV viral load. Higher viral loads affect the person’s health and may increase the risk of HIV transmission.
Why focus on gay men? Aren’t STIs a risk for everyone with HIV who is sexually active?
Yes. But recent research by Dr. Ann Burchell, Director of the OHTN Cohort Study, suggests that HIV-positive men who have sex with men are more likely to be co-infected with other STIs than women and heterosexual men with HIV.
Bacterial STIs are more infectious than HIV. They spread during unprotected anal or oral sex. Unlike HIV, which has a low risk of transmission during oral sex, bacterial STIs spread easily through oral sex.
Bacterial STIs are on the rise in Ontario. Since the early 2000s, gonorrhea has increased by 3%, chlamydia by 7%, and syphilis by 16% per year on average in the province. These STIs are more prevalent among HIV-positive gay men. In the OHTN Cohort Study, which tracks thousands of people in Ontario living with HIV, 21% of HIV-positive men who had sex with men also tested positive for syphilis at some point between 2000 and 2009. In Ontario, rates of new diagnoses of these STIs are significantly higher in gay men with HIV than in the general population.
Testing rates are up but there’s still room for improvement
Gay men who are living with HIV can protect themselves from the negative consequences of other STIs by getting tested more often and getting treated right away.
More gay men with HIV are going for STI testing. In the OHTN Cohort Study, the proportion of gay men with HIV being tested for syphilis rose from 2.7% in 2000 to 54.6% in 2009, and testing for chlamydia and gonorrhea rose from 18.6% in 2008 to 32.4% in 2011. However, even with these increases, not all men at risk are getting tested, and we are still not testing to guidelines. When Dr. Burchell looked at men who reported five or more sex partners in the previous three months, 22% were not tested for syphilis and 42% were not tested for chlamydia or gonorrhea in the subsequent 12 months. This falls far short of recommended annual testing for all sexually active gay, bisexual, and other men who have sex with men.
How often should gay men with HIV test for other STIs?
The best thing that gay men with HIV can do to protect their sexual health is to test regularly for other STIs: at least once a year and more often if they are having unprotected anal or oral sex with multiple or anonymous partners.
What are the take-home messages?
- If you are a gay man with HIV, being co-infected with a bacterial STI such as syphilis, chlamydia or gonorrhea can be hard on your health.
- These bacterial STIs are more infectious than HIV and can be spread through unprotected anal or oral sex.
- Condoms can reduce the risk of becoming infected with a bacterial STI.
- Regular testing and treatment for STIs can help gay men with HIV take charge of their health and reverse rising rates of bacterial STIs.
- Clinicians should encourage men with HIV to be tested for bacterial STIs as part of their routine care – for example, whenever they have a viral load test or more frequently if they have multiple partners.
- According to Dr. Burchell’s research, men who had a test for syphilis, gonorrhea or chlamydia one year tended to have also had one the year before, which means that STI testing can become part of regular care patterns.
- Gay men and their physicians should make sure to use both oral and rectal tests for STIs such as gonorrhea and chlamydia. Urine tests – the most common way to test for STIs – are not enough to find all the cases.
You don’t have to see your doctor for an STI test. Sexual health clinics across the province – including the Hassle Free Clinic in Toronto – offer drop-in testing.
To find a sexual health clinic near you, call the AIDS & Sexual Health Infoline at 1-800-668-2437 or visit www.sexualhealthontario.ca.
See Ann Burchell’s papers on: