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Type: Journal article
Title: Factors associated with early resumption of condomless anal sex among men who have sex with men after rectal chlamydia treatment
Author: Lau, A.
Kong, F.Y.S.
Fairley, C.K.
Templeton, D.J.
Amin, J.
Boyd, M.A.
Bradshaw, C.
Chen, M.Y.
Donovan, B.
Khaw, C.
Lewis, D.A.
McNulty, A.
Regan, D.G.
Ratnayake, M.
Hocking, J.S.
Citation: Sexually Transmitted Diseases, 2020; 47(6):389-394
Publisher: Wolters Kluwer
Issue Date: 2020
ISSN: 0148-5717
Statement of
Andrew Lau, Fabian Y.S. Kong, Christopher K. Fairley, David J. Templeton, Janaki Amin, Mark A. Boyd, Catriona Bradshaw, Marcus Y. Chen, Basil Donovan, Carole Khaw, David A. Lewis, Anna McNulty, David G. Regan, Mahesh Ratnayake, Jane S. Hocking (and on behalf of all RTS investigators)
Abstract: Background: The resumption of sexual activity shortly after commencing treatment for sexually transmitted infections (STIs) is poorly described despite contributing to onward transmission. With azithromycin remaining an option for rectal Chlamydia trachomatis, resuming sex too early after treatment may contribute to antimicrobial resistance because of exposure of newly acquired STIs to subinhibitory concentrations. Methods: Clinical and sexual behavioral data were collected from men participating in a trial assessing treatment efficacy for rectal chlamydia. Data were collected at recruitment and weekly for 3 weeks after commencing treatment. Outcome measures were resumption of any sexual activity or condomless receptive anal sex within 1, 2, or 3 weeks after commencing treatment. Generalized linear regression was used to calculate adjusted risk ratios (aRR) to identify associated factors. Results: Almost 1 in 10 men (9.5%; 95% confidence interval [CI], 7.2–12.1) resumed condomless receptive anal sex within 1 week of commencing treatment. This was associated with current preexposure prophylaxis use (aRR, 3.4; 95% CI, 2.5–4.8]) and having 9 or more sexual partners in the last 3 months (aRR, 3.2; 95% CI, 1.6–5.0). Most men (75.0%; 95% CI, 71.3–78.5) resumed any sexual activity within 3 weeks; this was associated with a greater number of sexual partners (4–8 partners; aRR, 1.2; 95% CI, 1.1–1.5; ≥9 partners; aRR, 1.5; 95% CI, 1.3–1.7). Conclusions: Resuming condomless receptive anal sex early after treatment may facilitate onward transmission and promote antimicrobial resistance for STIs. Although azithromycin remains a treatment option, this analysis highlights the need for new health promotion messages regarding early resumption of sex and continued surveillance for antimicrobial resistance.
Keywords: all RTS investigators
Chlamydia trachomatis
Chlamydia Infections
Anti-Bacterial Agents
Sexual Behavior
Homosexuality, Male
Unsafe Sex
Sexual Partners
Rights: © 2020 American Sexually Transmitted Diseases Association. All rights reserved.
DOI: 10.1097/OLQ.0000000000001166
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