Methods: This cross-sectional study used a standardized survey, and abstracted exam and lab data. The frequency of 5 types self-reported GCIs in the past 6 months were measured, dichotomized as ever vs. never for analysis: scratches, cuts or abrasions (scratches) to the penile or vaginal skin; genital soreness; bleeding of the genital skin; rectal bleeding; rectal soreness. Multivariable log-binomial models identified independent factors associated with GCI. Results are presented for scratches.
Results: As of May 2015, 269 patients have been enrolled: 102 women, 113 men who have sex with women (MSW), 54 men who have sex with men (MSM). Nearly half (47% of women and 52% of men) reported a past STI. At the time of the survey, 15% of women were diagnosed with chlamydia (cervix/urine nucleic acid amplification test or NAAT), 3% with gonorrhea (cervix/urine NAAT) and 42.1% were diagnosed with bacterial vaginosis by wet prep. Of men, 22.1% had chlamydia and 11% had gonorrhea identified by NAAT from pharynx, rectum, urine or urethra. Over the past 6 months, 36% of women, 24% of MSW, and 22% of MSM reported ever having GCI scratches. Notably, sex ever being “rougher than you would have liked” in the past 6 months was reported by 53% of women, 37% of MSW, and 44% of MSM. Factors associated with GCI-scratchat p<0.05 for women were: rough sex [aPRR=2.04], sex during menses [aPRR=2.20], digital penetration [aPRR=2.14]. Similar factors for MSM and MSW were being uncircumcised [aPRR=1.84] and higher education [aPRR=0.44]. Rough sex was associated with GCI for MSW [aPRR=3.67] but was not significant for MSM [aPRR=1.88, p=0.13].
Conclusion: The prevalence of self-reported GCI in this urban, U.S. STI clinic is similar to that of men and women in sub-Saharan Africa, suggesting a physiological rather than cultural mechanism. The hypothesized relationship between anaerobic bacteria and genital epithelial disruption is supported by the increased risk of GCI for uncircumcised men.
T. Mikati, None
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