BACKGROUND: Since 2000, large increases in syphilis, gonorrhea, and enteric diseases among men who have sex with men (MSM), a large proportion of whom are HIV-infected, have been noted worldwide. In 2013-14 we reported concurrent outbreaks of shigellosis (due to Shigella flexneri) and cryptosporidiosis (due to Cryptosporidium hominis) among MSM, 75% of whom were HIV-infected (CID 2014 Oct;59). Current U.S. strategy for HIV prevention emphasizes a medical model of antiretroviral treatment.
METHODS: We reviewed 2014-15 Minnesota disease surveillance data for cases and clusters among MSM.
RESULTS: In 2014, early syphilis cases increased 25% from 300 cases in 2013 to 416 cases; 68% were in MSM, 50% of whom were HIV-infected. In 2014, 20/80 (25%) of all tested cases of Shigella spp. with results had decreased susceptibility to azithromycin; 9 (45%) were HIV-infected, and of those, 8 reported MSM behavior. In 2015, 2 cases were part of a multistate outbreak of multidrug resistant S. sonnei among MSM linked by the same pulsed-field gel electrophoresis (PFGE) subtype. In 2015, there was a cluster of 4 Campylobacter coli cases among MSM linked by PFGE subtype; 3 were co-infected with S. flexneri and 2 were known to be HIV-infected. 20/156 (13%) of sporadic, adult male, non-refugee 2015 giardiasis cases were known to be MSM. Lastly, 1 fatal case of Neisseria meningitidis (Nm) in 2015 was in an HIV-infected MSM; the isolate was linked to ongoing Nm outbreaks among MSM in New York City and Chicago.
CONCLUSIONS: The U.S. strategy for HIV prevention emphasizing use of antiretrovirals for controlling the epidemic fails to prevent other diseases that can be transmitted through sexual practices. We have documented multiple cases and clusters of syphilis, meningococcal disease, and enteric infections among MSM, a large proportion of whom are HIV-infected, concurrent with the new HIV prevention strategies. Broader disease prevention efforts among MSM are needed to include diseases other than HIV and methods other than just antiretroviral treatment.