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Human papillomavirus (HPV) causes anal warts and anal squamous cell carcinoma (SCC). A higher incidence of anal cancer has been found among individuals previously diagnosed with anogenital warts. We aimed to investigate the association between anal warts and the presumed anal SCC precursor high-grade squamous intraepithelial lesion (HSIL), among participants in the Study of the Prevention of Anal Cancer (SPANC). SPANC was a longitudinal study of anal HPV infections and related lesions among gay and bisexual men (GBM) age 35 years and older, in Sydney, Australia. Anal cytology and high-resolution anoscopy were performed. Logistic regression was used to investigate the association between clinically diagnosed anal warts and intra-anal composite-HSIL (cytology and/or histology) at the baseline visit. The prevalence of HSIL within biopsies from intra-anal warts was calculated. Laser capture microdissection (LCM) and HPV-genotyping was performed on HSIL lesions. Among 616 participants at study entry, 165 (26.8%) and 51 (8.3%) had intra-anal and perianal warts, respectively. Warts were associated with composite-HSIL, even after adjustment for HIV status, age, lifetime receptive anal intercourse partner number, and smoking (perianal: aOR 2.13, 95% CI 1.17-3.87

From January 2014 to December 2015, the overall yield of sexually transmitted infections testing among asymptomatic MSM was two-fold higher at a community-based versus clinic-based service. Compared with the clinic-based service, yield of chlamydia (9.0% vs 4.9%; P = 0.010), gonorrhea (6.5% vs 3.1%; Plt; 0.001), and infectious syphilis (0.9% vs 0.1%; P = 0.024) were all higher at the community-based service.

ObjectivesPharyngeal gonorrhoea disproportionately affects men who have sex with men (MSM). We explored temporal trends in pharyngeal gonorrhoea positivity among MSM compared with anorectal and urogenital positivity.MethodsData (2011–2015) were extracted from 41 publicly funded sexual health clinics participating in a national surveillance network. Positivity was defined as the proportion of first-visit testing occasions where gonorrhoea was detected. Logistic regression explored trends in positivity and correlates of positive pharyngeal tests.ResultsFrom 2011 to 2015, 24 792 MSM tested (16 710 pharyngeal, 19 810 urogenital and 15 974 anorectal first-visit tests). Pharyngeal positivity increased by 183% from 139/3509 (4.0%) in 2011 to 397/3509 (11.3%) in 2015, p-trend ConclusionTemporal increases in gonorrhoea positivity occurred at all anatomical sites, with the greatest increase in the pharynx. Risk factors could be used to help to develop testing and prevention strategies among MSM at highest risk. Strengthening sexual health service delivery, testing and surveillance remain priorities for pharyngeal gonorrhoea control.

ObjectivesSexually transmitted infection (STI) notifications are increasing among older individuals. Many older gay and bisexual men (GBM) are sexually active and have multiple partners. We aimed to investigate the prevalence, incidence and predictors of anal chlamydia, anal gonorrhoea and syphilis in older GBM.MethodsThe Study for the Prevention of Anal Cancer (SPANC) was a prospective cohort study of HPV infections and related anal lesions among community-recruited GBM age ≥ 35 years in Sydney, Australia. At baseline and subsequent annual visits, recent STI diagnoses were collected via questionnaire (‘interval diagnoses’) and STI testing occurred (‘study visit diagnoses’). Baseline STI prevalence was calculated using study visit diagnoses. Incidence of anal chlamydia and gonorrhoea was calculated using interval and study visit diagnoses. Syphilis incidence was calculated using interval diagnoses. Univariate and multivariate analysis using Cox proportional hazards were undertaken to investigate the association between risk factors and incident STI.ResultsAmong 617 GBM, the median age was 49 years (range 35–79) and 35.8% (n=221) were HIV-positive. At baseline, STI prevalence was: anal chlamydia 2.3% (n=14); anal gonorrhoea 0.5% (n=3) and syphilis 1.0% (n=6). During 1428 person-years of follow-up (PYFU), the incidence (per 100 PYFU) of anal chlamydia, anal gonorrhoea and syphilis was 10.40 (95% CI 8.82 to 12.25), 9.11 (95% CI 7.64 to 10.85) and 5.47 (95% CI 4.38 to 6.84), respectively. In multivariate analysis, HIV-positivity, higher number of recent condomless receptive anal intercourse partners and baseline methamphetamine use were associated with each STI. Sex with ‘fuck-buddies’ was associated with anal chlamydia and gonorrhoea. Age was not associated with any STI.DiscussionThere was a high incidence of STI among SPANC participants. Age should not be used as a proxy for sexual risk and older GBM require a detailed sexual behaviour and recreational drug use history. Interventions that specifically target STI risk among older GBM should be considered.

Pharyngeal gonorrhoea disproportionately affects men who have sex with men (MSM). We explored temporal trends in pharyngeal gonorrhoea positivity among MSM compared with anorectal and urogenital positivity.Data (2011-2015) were extracted from 41 publicly funded sexual health clinics participating in a national surveillance network. Positivity was defined as the proportion of first-visit testing occasions where gonorrhoea was detected. Logistic regression explored trends in positivity and correlates of positive pharyngeal tests.From 2011 to 2015, 24 792 MSM tested (16 710 pharyngeal, 19 810 urogenital and 15 974 anorectal first-visit tests). Pharyngeal positivity increased by 183% from 139/3509 (4.0%) in 2011 to 397/3509 (11.3%) in 2015, p-trend0.001; urogenital positivity by 39% from 257/4615 (5.6%) to 295/3783 (7.8%), p-trend=0.006; and anorectal positivity by 87% from 160/3469 (4.6%) to 286/3334 (8.6%), p-trend0.001. The annual temporal increase in positivity was greater in the pharynx (OR 1.33; 95% CI 1.27 to 1.38) than at urogenital (OR 1.06; 95% CI 1.02 to 1.10) and anorectal (OR 1.16; 95% CI 1.11 to 1.21) sites. Factors independently associated with pharyngeal gonorrhoea were: younger age (p0.001), higher numbers of recent sexual partners (p-trend=0.004), contact with a person with a diagnosed STI (p0.001), injecting drug use (p0.001), anogenital symptoms (p0.001) and HIV-positive status (p=0.050).Temporal increases in gonorrhoea positivity occurred at all anatomical sites, with the greatest increase in the pharynx. Risk factors could be used to help to develop testing and prevention strategies among MSM at highest risk. Strengthening sexual health service delivery, testing and surveillance remain priorities for pharyngeal gonorrhoea control.

Sexually transmitted infection (STI) notifications are increasing among older individuals. Many older gay and bisexual men (GBM) are sexually active and have multiple partners. We aimed to investigate the prevalence, incidence and predictors of anal chlamydia, anal gonorrhoea and syphilis in older GBM.The Study for the Prevention of Anal Cancer (SPANC) was a prospective cohort study of HPV infections and related anal lesions among community-recruited GBM age ≥ 35 years in Sydney, Australia. At baseline and subsequent annual visits, recent STI diagnoses were collected via questionnaire ('interval diagnoses') and STI testing occurred ('study visit diagnoses'). Baseline STI prevalence was calculated using study visit diagnoses. Incidence of anal chlamydia and gonorrhoea was calculated using interval and study visit diagnoses. Syphilis incidence was calculated using interval diagnoses. Univariate and multivariate analysis using Cox proportional hazards were undertaken to investigate the association between risk factors and incident STI.Among 617 GBM, the median age was 49 years (range 35-79) and 35.8% (n=221) were HIV-positive. At baseline, STI prevalence was: anal chlamydia 2.3% (n=14); anal gonorrhoea 0.5% (n=3) and syphilis 1.0% (n=6). During 1428 person-years of follow-up (PYFU), the incidence (per 100 PYFU) of anal chlamydia, anal gonorrhoea and syphilis was 10.40 (95% CI 8.82 to 12.25), 9.11 (95% CI 7.64 to 10.85) and 5.47 (95% CI 4.38 to 6.84), respectively. In multivariate analysis, HIV-positivity, higher number of recent condomless receptive anal intercourse partners and baseline methamphetamine use were associated with each STI. Sex with 'fuck-buddies' was associated with anal chlamydia and gonorrhoea. Age was not associated with any STI.There was a high incidence of STI among SPANC participants. Age should not be used as a proxy for sexual risk and older GBM require a detailed sexual behaviour and recreational drug use history. Interventions that specifically target STI risk among older GBM should be considered.

Background The association between anal high-grade squamous intraepithelial lesion (HSIL) and anal symptoms has not been systematically investigated. Methods The Study of Prevention of Anal Cancer is a prospective cohort study of men who have sex with men (MSM) ≥ 35 years old in Sydney, Australia. Self-reported symptoms were collected. Anal cytology and high-resolution anoscopy were undertaken. Using baseline visit data, men negative for squamous intra-epithelial lesion (SIL) were compared with men diagnosed with composite-HSIL (cytology and/or histology). Logistic regression analyses were performed to assess the association of symptoms with HSIL. Results Among 414 MSM included (composite-HSIL (n = 231); negative for SIL (n = 183)), 306 (73.9%) reported symptom(s) within the last 6 months. There was no association between any symptom and composite-HSIL. A significant association between anal lump and a larger burden of HSIL (at least 2 intra-anal octants) (anal lump within last month: p = 0.014; anal lump within last 6 months: p = 0.010) became non-significant after adjusting for HIV-status and recent anal warts (anal lump within last month: p = 0.057; anal lump within last 6 months: p = 0.182). Conclusions Among MSM age 35 years and older, most anal symptoms are not a useful marker of anal HSIL.

Introduction Gay and bisexual men (GBM) are disproportionately affected by Chlamydia trachomatis (CT). A steady increase in CT notifications has been observed in Australia’s most populous state (NSW), with an increasing proportion being pharyngeal CT (PCT) notifications. Our aim was to investigate temporal trends and associated behavioural factors of PCT compared to anogenital CT among GBM attending NSW sexual health clinics. Methods Clinical data were extracted in early 2017 for the period 2010–2016 from 26 NSW clinics. Positive test yield (“yield”) was defined as the proportion of testing occasions where CT was detected. Results 23,423 GBM were tested on 84 385 occasions during the 7 year study period to end 2016. Yield of genital testing was 8.8% (95%CI: 8.5–9.0), increasing by 17% over the study period (8.1%–9.5%, p Conclusion The likelihood of detecting CT among GBM has increased over time with by far the greatest increase in positive test yield occurring in the pharynx. The same factors were associated with CT detection at all sites. Given that most untreated PCT persists on average for 2 years, is readily transmitted to anogenital sites and that one in 20 of all CT infections would be missed, consideration should be given to routine screening of the pharynx in other countries to reduce CT transmission among GBM.

Background A substantial increase in gonorrhoea notifications in New South Wales has been observed in recent years. Methods: We assessed yield of testing and characteristics of those diagnosed with gonorrhoea from January 2008 to December 2013 at RPA Sexual Health in the inner-west of Sydney. Yield was defined as the proportion of testing occasions which were positive for gonorrhoea. Generalised estimating equations were used to calculate trends in yield over time. Results: During the 6-year study period, 6456 individuals (4308 males, 2124 females, 24 transgender individuals) were tested on 12 799 occasions; this included 2441 gay and bisexual men (GBM) who were tested on 6945 occasions. Over the study period there was a significant increase in testing at genital, anorectal and pharyngeal sites (P-trend

Background The aim of the present study was to describe the temporal trends in Chlamydia trachomatis (CT) testing yield among gay and bisexual male (GBM) sexual health clinic attendees in Sydney. Methods: All CT testing occasions among GBM from January 2011 to December 2014 were reviewed. Yield was defined as the proportion of testing occasions where CT was detected. Results: In all, 2917 GBM were tested on 5445 occasions. CT was detected on 439 (8.1%; 95% confidence interval (CI) 7.4–8.8%) occasions. Pharyngeal, urethral and anorectal CT were detected on 74 (1.4%; 95% CI 1.1–1.7%), 109 (2.0%; 95% CI 1.7–2.4%) and 333 (6.1%; 95% CI 5.5–6.8%) occasions respectively. Over the study period, there was a significant increase in pharyngeal CT yield (from 0.70% to 1.6%; odds ratio (OR) 1.25; 95% CI 1.01–1.55; Ptrend = 0.043), which remained borderline significant (OR 1.22; 95% CI 0.99–1.52; P = 0.067) when adjusted for age. There was no change in yield of either urethral or anorectal infections. Almost half the pharyngeal CT (n = 35; 47.3%) occurred without concurrent anogenital infection. Excluding those who would have received anti-chlamydial treatment for another reason, 27.0% of pharyngeal and 4.6% of all CT infections would not have been treated without pharyngeal testing. Conclusions: A recent temporal increase was observed in the yield of pharyngeal CT without a concurrent increase in anogenital yield. Ongoing surveillance is warranted to inform testing guidelines for GBM.

Introduction Australian STI testing guidelines recommend regular Chlamydia trachomatis (CT) testing at pharyngeal and anogenital sites among asymptomatic men who have sex with men (MSM). Our aim was to investigate temporal trends and characteristics of clinic-diagnosed pharyngeal and anogenital CT among MSM. Methods Testing was performed using Aptima Combo 2 (Hologic, US). Data were extracted from the laboratory database and medical records. Statistical analyses were performed using STATA13 (Statcorp, College Station, TX). Results During the study period 2919 MSM were tested on 6850 occasions, and 556 (8.2%) episodes of CT were diagnosed. Pharyngeal (PCT), urethral (UCT) and rectal (RCT) positivity rates were 1.2%, 2.3% and 6.2%, respectively. From 2011–2014, there was a significant increase in number of tests performed, (999–2834, p-trend Conclusion CT positivity remained stable despite substantially increased testing. The temporal decline in symptomatic infections likely reflects a recent policy shift towards regular asymptomatic testing for MSM. Despite a relatively low prevalence of PCT, men with PCT had more sexual partners than men with anogenital CT and close to half the pharyngeal infections would have remained untreated without pharyngeal testing. There may be valuable public health benefits of regular PCT testing among MSM. Disclosure of interest statement No disclosures of interest.