The Epidemiology of STIs in the HIV and

The Epidemiology of STIs in the HIV and AIDS Era A/Prof Darren Russell Cairns Sexual Health Service James Cook University #IAS 2017 | @IAS_Conference

#IAS 2017 | @IAS_conference Conflict of Interest • No conflicts of interest to declare

#IAS 2017 | @IAS_conference Epidemiology of STIs versus HIV • You only find what you look for… – Generally poorer testing and notification systems for STIs – Many countries have no STI surveillance system in place – Where data exists, it may be patchy, or not current • STIs are ‘the poor cousins’ of HIV

Figure 1 #IAS 2017 | @IAS_conference • WHO regional estimates of new cases of 4 curable STIs • Data are estimated numbers of incident cases in millions for chlamydia, gonorrhoea, syphilis, and trichomoniasis in 2012, by WHO region. The Lancet Infectious Diseases 2017 17, e 235 -e 279 DOI: (10. 1016/S 1473 -3099(17)30310 -9)

#IAS 2017 | @IAS_conference Historic Trends in Gonorrhoea in the UK Penicillin G AIDS Hughes and Field, Future Microbiol. (2015) 10(1), 35– 51

#IAS 2017 | @IAS_conference Crude mortality rates for syphilis and AIDS USA 1900 -1996

#IAS 2017 | @IAS_conference Syphilis diagnoses in high income countries USA Germany Canada Sweden

Reported STIs in France: National Data for Syphilis and Gonorrhoea #IAS 2017 | @IAS_conference INVS Santé Publique France 2016

#IAS 2017 | @IAS_conference Syphilis incidence in two MSM cohorts in Sydney Incidence per 100 person years 95% confidence interval HIM (HIV neg) p. H (HIV pos) 0. 5 3. 6 0. 3 - 0. 7 1. 7 - 6. 5 After adjusting for age: HR if HIV+ 9. 2 (95% CI, 3. 6 - 23. 3) Jin F et al. Sexual Health 2009; 6: 281

Figure 10 #IAS 2017 | @IAS_conference New diagnoses of STIs from 1996 to 2015 in MSM in England The Lancet Infectious Diseases 2017 17, e 235 -e 279 DOI: (10. 1016/S 1473 -3099(17)30310 -9)

| @IAS_conference Reported STIs in the US: National#IAS 2017 Data for Chlamydia, Gonorrhoea and Syphilis § 2015: Second year in a row with an increase in all 3 STIs § 1. 5 million cases of chlamydia, 400, 000 gonorrhoea and 24, 000 syphilis, increasing “at an alarming rate” among MSM CDC fact sheet October 2016

#IAS 2017 | @IAS_conference Pr. EP and STIs • The QPr. EPd study is based in Queensland, Australia • >1800 MSM on Pr. EP at 22 sites • STI rate at entry = 12. 4% – At 3 months =12. 1% – At 6 months = 13. 3% – At 12 months = ? ?

Figure 11 #IAS 2017 | @IAS_conference Condom use for anal sex in MSM in Sydney, 1997 -2016 The Lancet Infectious Diseases 2017 17, e 235 -e 279 DOI: (10. 1016/S 1473 -3099(17)30310 -9) Copyright

#IAS 2017 | @IAS_conference Infectious syphilis in Queensland by Indigenous status, 2002 -2016 Source: NOCS, Australia

#IAS 2017 | @IAS_conference Warts diagnoses (%) Proportion of Australian born women diagnosed with genital warts at first visit, by age group, 2004 -2013 22 <21 years 20 21 -30 years 18 >30 years 16 14 12 10 8 6 4 85% 96% 2 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Ali H et al. BMJ 2013 (extended d

#IAS 2017 | @IAS_conference Acknowledgements • Pr Jean-Michel Molina (Paris) • Prof Basil Donovan (Sydney) • Simon Doyle. Adams, Michael Rodriguez, Rohan Pratt (Cairns)