Diagnoses of sexually transmissible infections in HIV-serodiscordant male couples in Australia, Brazil and Thailand

James Gray; Fengyi Jin; Nittaya Phanuphak; Ruth K. Friedman; Christopher K. Fairley; David J. Templeton; Iryna Zablotska-Manos; Jennifer Hoy; David Baker; Mayara Secco Torres Silva; Andrew Grulich; Benjamin Bavinton

doi:10.1071/SH24208

RESEARCH ARTICLE (Open Access)

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Diagnoses of sexually transmissible infections in HIV-serodiscordant male couples in Australia, Brazil and Thailand

James Gray

^A ^* , Fengyi Jin ^A , Nittaya Phanuphak

^B , Ruth K. Friedman ^C , Christopher K. Fairley

^D ^E , David J. Templeton ^A ^F ^G , Iryna Zablotska-Manos ^H ^I , Jennifer Hoy ^J , David Baker ^K , Mayara Secco Torres Silva ^C , Andrew Grulich ^A , Benjamin Bavinton

^A and for the Opposites Attract study group^§

+ Author Affiliations

- Author Affiliations

^A The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.

^B Institute of HIV Research and Innovation, Bangkok, Thailand.

^C Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.

^D Melbourne Sexual Health Centre, Melbourne, Vic, Australia.

^E Central Clinical School, Monash University, Melbourne, Vic, Australia.

^F Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia.

^G Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.

^H Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.

^I Western Sydney Sexual Health, Western Sydney Local Health District, Sydney, NSW, Australia.

^J Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic, Australia.

^K East Sydney Doctors, Sydney, NSW, Australia.

^* Correspondence to: jgray@kirby.unsw.edu.au

Handling Editor: Eric P.F. Chow

Sexual Health 22, SH24208 https://doi.org/10.1071/SH24208

Submitted: 18 November 2024 Accepted: 15 April 2025 Published: 6 May 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

In an era of biomedical prevention of HIV transmission, prevention of sexually transmissible infections (STIs) remains a priority for male HIV-serodiscordant couples. Three common STIs in populations of gay and bisexual men are chlamydia, gonorrhoea and syphilis.

Methods

We examined the incidence of these three infections in 343 male HIV-serodiscordant couples in Australia, Brazil and Thailand. The couples participated in a prospective, observational cohort study that included regular STI testing and behavioural surveys for HIV-negative partners (HNP).

Results

HIV-positive partners (HPP; IR = 22.9/100 person-years, 95% CI: 19.3–27.0) had a higher incidence rate of any STI (22.9/100 person-years, 95% CI: 19.3–27.0) compared with HNP (14.9/100 person-years, 95% CI: 12.1–18.3). It was more common for only the HPP (n = 107/343, 7.1%) or only the HNP (n = 60, 4.0%) to have an STI than for both to have an STI (n = 29/343, 1.9%). Higher STI incidence was associated with vocational education (HNP: aHR = 2.19, P = 0.005), full-time employment (HPP: aHR = 1.61, P = 0.016), living in Brazil (HPP: aHR = 1.85, P = 0.017) or Thailand (HPP: aHR = 1.98, P = 0.008), having anal sex with other partners (HNP: aHR = 2.42, P = 0.003; HPP: aHR = 2.87, P < 0.001) and recent PrEP use (HPP: aHR = 1.51, P = 0.044). Lower STI incidence was associated with age >40 years (HNP: aHR = 0.49, P = 0.021; HPP: aHR = 0.46, P = 0.006), full-time employment (HNP: aHR = 0.56, P = 0.016) and >5 years since first sex with the study partner (HNP: aHR = 0.50, P = 0.036).

Conclusions

There were differences in STI diagnoses within HIV-serodiscordant couples, particularly based on their agreements about sex outside the relationship. Interventions aimed at strengthening these agreements with commitments to STI testing could be effective in reducing the incidence of STIs.

Keywords: agreements, chlamydia, gonorrhoea, HIV, serodiscordant, STD, STI, syphilis.

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