Multidrug-Resistant Pathogens Common in MSM With Gastroenteritis

By Reuters Staff

November 04, 2019

NEW YORK (Reuters Health) - Men who have sex with men (MSM) have high rates of infectious gastroenteritis, and infections with multidrug-resistant pathogens are common, according to new findings.

MSM with multiple partners are known to have a higher rate of intestinal infection with Shigella, Campylobacter and Giardia compared with the population overall, Dr. Kira L. Newman of the University of Washington School of Medicine in Seattle and her colleagues note in in Clinical Infectious Diseases, online October 17.

To better understand the causes of infectious diarrhea in MSM since the introduction of antiretroviral therapy for HIV and sensitive molecular testing, the authors looked at 235 men who had recently undergone multiplex stool polymerase chain reaction (PCR) testing.

There were 268 episodes of gastroenteritis in total, and 131 patients had 151 episodes with positive PCR testing. Sixty-three percent of the men in the study had HIV.

Of the positive tests, 88.7% detected a bacterial pathogen, 26% a virus and 40% a parasite. Forty-three percent of positive tests included two or more pathogens.

The most commonly identified bacteria were Escherichia coli (33.1% of positive samples), Shigella (30.5%) and Campylobacter (17.2%).

All of the 19 Shigella isolates tested were resistant to ampicillin and trimethoprim-sulfamethoxazole, and 17 were resistant to azithromycin. Of nine Campylobacter isolates tested, seven were resistant to ciprofloxacin and eight were resistant to erythromycin.

Clinical presentation and outcomes were similar for men with and without HIV.

Three-quarters of patients with positive pathogen tests were prescribed antibiotics.

"We suspect that the high rate of testing and treatment in our study is due to 2 factors," Dr. Newman and colleagues note. "First, many consider people living with HIV to be immunocompromised regardless of CD4 count and may therefore test and treat people living with HIV based on immunocompromised guideline recommendations. Second, there is active discussion in the STD community regarding testing and treating of gastroenteritis in MSM, with some advocating for increased testing and treatment in MSM to prevent further transmission."

They conclude, "Antimicrobial treatment options are becoming limited, and persistent evidence of transmission through sexual contact suggests that current prevention strategies are ineffective. New approaches are needed to detect, treat, and prevent enteric infections in MSM."


Clin Infect Dis 2019.