2503. Gonorrhea (GC) and Chlamydia (CT) Infection in a Large, Well-Characterized Military Cohort: Prevalence, Incidence, Site of Infection, and Patient Characteristics.
Session: Oral Abstract Session: STIs - Diagnostics and Therapy
Saturday, October 7, 2017: 3:15 PM
Room: 07AB

Background:  In the US military, routine extra-genital (EG) GC/CT testing in persons living with HIV was implemented in 2012. This study examines the prevalence/incidence and risk factors associated with genital (GU) and EG GC/CT infections in the US Military HIV Natural History Study (NHS), a cohort of HIV-infected Department of Defense beneficiaries.

Methods: Since 2012, willing NHS subjects have undergone nucleic acid-based tests (NAAT) to identify anorectal (AR)/ pharyngeal (PH) GC/CT infections. Incident cases had a positive test following an initial negative test. Risk factors for incident GC/CT infections were assessed with a multivariate Cox proportional hazards model.

Results: A total of 405 GC and 457 CT infections were observed among 1998 subjects (median age 28.7 years, 94% male, 44.1% African-American [AA]); 21% of GC and 18% of CT cases were re-infections.  The incidence of AR GC, PH GC, and AR CT increased over time (p=0.02, p= 0.03 and p=0.02, respectively). Incident GC infections were associated with younger age [HR 0.61 per 5 year increase (0.57-0.66)], AA ethnicity [HR 1.46 (1.06-2.00)], higher viral load [HR 1.63 per log increase (1.47-1.80)] and a prior history of syphilis [HR 2.20 (1.62-2.99)]. Incident CT infections were associated with younger age [HR 0.7 per 5 year increase (0.66-0.74)], male gender [HR 5.82 (1.86-18.20)], higher viral load [HR 1.61 for each log increase (1.47-1.76)], lower CD4 count [HR 0.86 per 200 cell increase (0.79-0.95)], prior GC [HR 1.55 (1.15-2.08)] and prior syphilis [HR 2.16 (1.67-2.79)].

Conclusion:  Incident AR GC and CT infections are increasing in the NHS and approximately 20% of infections were repeat infections. The increased incidence is attributable at-least in part to the increased uptake of EG testing. Our study highlights the importance of prevention in positive programs to reduce the risk of HIV transmission.

Incidence Rate Per 100 Person-Years (95% Confidence Interval) by Site

GC

CT

Year

AR *

PH *

GU

AR*

PH

GU

2012

1.3 (0.7-2.3)

1.9 (1.1-2.9)

2 (1.2-3)

2.7 (1.8-4)

1 (0.5-1.9)

4.4 (3.2-5.9)

2013

1.8 (1.1-2.6)

2 (1.3-2.8)

1 (0.6-1.7)

2.5 (1.8-3.5)

0.5 (0.2-1)

2.2 (1.5-3.1)

2014

1.2 (0.7-1.9)

1.3 (0.7-2)

1.2 (0.7-1.9)

2.4 (1.7-3.4)

0.4 (0.2-1)

1.5 (0.9-2.2)

2015

2.1 (1.4-3.1)

2.3 (1.6-3.2)

1.1 (0.6-1.8)

3.1 (2.3-4.3)

0.8 (0.4-1.5)

1.8 (1.1-2.6)

2016

2 (1.3-3)

2.4 (1.6-3.4)

1.1 (0.6-1.8)

3.8 (2.7-5)

0.8 (0.4-1.5)

1.5 (0.9-2.4)

*significant change over time

Christa Eickhoff, MD, Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD, Xun Wang, MS, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, Robert Deiss, MD, Naval Medical Center San Diego, San Diego, CA, Jason Okulicz, MD, Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, TX, Thomas O'Bryan, MD, San Antonio Military Medical Center, Fort Sam Houston, TX, Ryan Maves, MD, FCCP, FIDSA, Infectious Diseases, Naval Medical Center San Diego, San Diego, CA, Christina Schofield, MD FACP, FIDSA, Madigan Army Medical Center, Tacoma, WA, Tomas Ferguson, MD, FIDSA, Department of Medicine, Tripler Army Medical Center, Honolulu, HI, Timothy J. Whitman, DO, Walter Reed National Military Medical Center, Bethesda, MD, Brian Agan, MD, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD and Anuradha Ganesan, MD, MPH, Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD

Disclosures:

C. Eickhoff, None

X. Wang, None

R. Deiss, None

J. Okulicz, None

T. O'Bryan, None

R. Maves, None

C. Schofield, None

T. Ferguson, None

T. J. Whitman, None

B. Agan, None

A. Ganesan, None

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