As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men

Mark Richard Stenger; Stefan Baral; Shauna Stahlman; Dan Wohlfeiler; Jerusha E. Barton; Thomas Peterman

doi:10.1071/SH16104

REVIEW (Open Access)

As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men

Mark Richard Stenger ^A ^F , Stefan Baral ^B , Shauna Stahlman ^B , Dan Wohlfeiler ^C , Jerusha E. Barton ^D and Thomas Peterman ^E

+ Author Affiliations

- Author Affiliations

^A US Centers for Disease Control and Prevention – Division of STD Prevention, Mail Stop E-63 1600 Clifton Road NE, Atlanta, GA 30333, USA.

^B Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA.

^C University of California San Francisco, San Francisco, CA 94143, USA.

^D US Centers For Disease Control and Prevention – Division of STD Prevention (ORISE Fellow), Mailstop E-63, Atlanta, GA 30333, USA.

^E Centers for Disease Control and Prevention – Division of STD Prevention, Mailstop E-02 CDC, Atlanta, GA 30333, USA.

^F Corresponding author. Email: mstenger@cdc.gov

Sexual Health 14(1) 18-27 https://doi.org/10.1071/SH16104
Submitted: 1 June 2016 Accepted: 28 June 2016 Published: 2 September 2016

Journal Compilation © CSIRO Publishing 2017 Open Access CC BY-NC-ND

Abstract

The trajectory of sexually transmissible infection (STI) incidence among gay and other men who have sex with men (MSM) suggests that incidence will likely remain high in the near future. STIs were hyperendemic globally among MSM in the decades preceding the HIV epidemic. Significant changes among MSM as a response to the HIV epidemic, caused STI incidence to decline, reaching historical nadirs in the mid-1990s. With the advent of antiretroviral treatment (ART), HIV-related mortality and morbidity declined significantly in that decade. Concurrently, STI incidence resurged among MSM and increased in scope and geographic magnitude. By 2000, bacterial STIs were universally resurgent among MSM, reaching or exceeding pre-HIV levels. While the evidence base necessary for assessing the burden STIs among MSM, both across time and across regions, continues to be lacking, recent progress has been made in this respect. Current epidemiology indicates a continuing and increasing trajectory of STI incidence among MSM. Yet increased reported case incidence of gonorrhoea is likely confounded by additional screening and identification of an existing burden of infection. Conversely, more MSM may be diagnosed and treated in the context of HIV care or as part of routine management of pre-exposure prophylaxis (PrEP), potentially reducing transmission. Optimistically, uptake of human papillomavirus (HPV) vaccination may lead to a near-elimination of genital warts and reductions in HPV-related cancers. Moreover, structural changes are occurring with respect to sexual minorities in social and civic life that may offer new opportunities, as well as exacerbate existing challenges, for STI prevention among MSM.

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