Men sex with men (MSM) are accepted as a hidden key population in the dissemination of HIV in Turkey. Understanding sexual behaviours and Sexually Transmitted Infections (STI) frequency in MSM living with HIV is important to provide appropriate health and control policies.
Methods
Sexual anamnesis including 5Ps were taken with triple-site (urine, pharyngeal and rectal swab) screening tests, which were performed according to the recommendations in the HIV follow up guidelines, from 45 MSM living with HIV, who were followed and consecutively attended to their control visit Marmara University Pendik Education and Training Hospital, in Istanbul, in 2018.
Results
24.4 % and 26.7 % of participants tested positive for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), respectively. This ratio decreased to 6.7% if urine was the only sample taken to be tested. Syphilis seropositivity increased from 18% to 34% during the HIV diagnosis to triple testing time, which is a median period of 28 months.
Conclusion
The data obtained emphasizes the screening and reimbursement of triple testing in key population groups.
DerinO. Gender and age trends in HIV incidence in Turkey between 1990 and 2021: Joinpoint and age-period-cohort analyses. Medicina (Kaunas)2024; 60(8): 1357.
JansenKSteffenGPotthoffA, et al.STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany. BMC Infect Dis2020; 20(1): 110.
10.
YangZWeiLXuZ, et al.HIV risk and influence factors among MSM who had sought sexual partners in core venues: a continuous sentinel surveillance in 2010-2022. Front Public Health2024; 12: 1476642.
11.
Verhaegh-HaasnootADukers-MuijrersNHHoebeCJ. High burden of STI and HIV in male sex workers working as internet escorts for men in an observational study: a hidden key population compared with female sex workers and other men who have sex with men. BMC Infect Dis2015; 15: 291.
12.
NazliAGarnerAGokenginD. Awareness of HIV pre-exposure prophylaxis among men who have sex with men using apps for sexual encounters in Turkiye. Int J STD AIDS2022; 33(13): 1124–1133.
13.
GökenginDNooriTAlemanyA, et al.Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe. Lancet Reg Health Eur2023; 34: 100738.
14.
SaundersJDeeringJDewsnapC, et al.British Association for Sexual Health and HIV (BASHH) UK national guideline for the use of doxycycline post-exposure prophylaxis (DoxyPEP) for the prevention of syphilis, 2025. Int J STD AIDS2025: 9564624251352053.
KoedijkFDvan BergenJEDukers-MuijrersNH, et al.The value of testing multiple anatomic sites for gonorrhoea and chlamydia in sexually transmitted infection centres in The Netherlands, 2006-2010. Int J STD AIDS2012; 23(9): 626–631.
KojimaNKlausnerJD. Patients may accurately self-collect pharyngeal and rectal specimens for Neisseria gonorrhoeae and Chlamydia trachomatis infection: but is there benefit?Clin Infect Dis2021; 73(9): e3181–e3182.
20.
KenyonCHerrmannBHughesG, et al.Management of asymptomatic sexually transmitted infections in Europe: towards a differentiated, evidence-based approach. Lancet Reg Health Eur2023; 34: 100743.
21.
GeislerWM. Duration of untreated, uncomplicated Chlamydia trachomatis genital infection and factors associated with chlamydia resolution: a review of human studies. J Infect Dis2010; 201(Suppl 2): S104–S113.
22.
VanbaelenTTsoumanisAFlorenceE, et al.Effect of screening for Neisseria gonorrhoeae and Chlamydia trachomatis on incidence of these infections in men who have sex with men and transgender women taking HIV pre-exposure prophylaxis (the Gonoscreen study): results from a randomised, multicentre, controlled trial. Lancet HIV2024; 11(4): e233–e244.
23.
MarcusUMirandolaMSchinkSB, et al.Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men-is it time to re-evaluate STI-screening as a control strategy?PLoS One2021; 16(3): e0248582.
24.
WilliamsEWilliamsonDAHockingJS. Frequent screening for asymptomatic chlamydia and gonorrhoea infections in men who have sex with men: time to re-evaluate?Lancet Infect Dis2023; 23(12): e558–e566.
ErdincFSDokuzoguzBUnalS, et al.Temporal trends in the epidemiology of HIV in Turkey. Curr HIV Res2020; 18(4): 258–266.
29.
GokenginDAybekGAralSO, et al.Programmatic mapping and size estimation of female sex workers, transgender sex workers and men who have sex with men in İstanbul and Ankara, Turkey. Sex Transm Infect2021; 97(8): 590–595.
30.
European Centre for Disease Prevention and Control. Continuum of HIV care. Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2022 progress report. Stockholm: ECDC, 2023. https://www.ecdc.europa.eu/sites/default/files/documents/CoC_HIV_0.pdf (accessed 4 August 2025).
31.
Yağcı ÇağlayıkDSiliUTükenmez TigenE, et al.Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi’nde takip edilen HIV ile yaşayan erişkin bireylerde sifiliz seropozitifliğinin araştırılması, 2024. Turk Hij Den Biyol Derg2024; 81(4): 431–438.
AyazÇMKarakaplanNDİnkayaAÇ, et al.Investigation of the frequency of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in men living with HIV in terms of sociodemographic characteristics and behavioral risk factors. Mikrobiyoloji Bulteni2023; 57(3): 378–389. Turkish.
HornerPDondersGCusiniM, et al.Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? - a position statement from the European STI Guidelines Editorial Board. J Eur Acad Dermatol Venereol2018; 32(11): 1845–1851.
Este’LamiM. Rumi and the Universality of his message. Islam Christian-Muslim Relat2003; 14(4): 429–524.
41.
TokerA. Love as reflected in the poetry of Jalaluddin Rumi and Yunus Emre. Agathos: An International Review of the Humanities & Social Sciences2024; 15(2): 177–193.
42.
Anonymous. Muslim and gay: seeking identity coherence in New Zealand. Cult Health Sex2016; 18(3): 280–293.
43.
BakacakAGOktemP. Homosexuality in Turkey: strategies for managing heterosexism. J Homosex2014; 61(6): 817–846.
44.
DaiZZhongXPengB, et al.Socio-demographics, sexual behaviours, and use of HIV prevention services among men who have sex with men and women in Western China. Int J STD AIDS2016; 27(2): 133–140.
45.
AaflnQSousaÁFLAraújoTME, et al.High rates of unprotected receptive anal sex and vulnerabilities to HIV infection among Brazilian men who have sex with men. Int J STD AIDS2021; 32(4): 368–377.
46.
ZhangXJiaMChenM, et al.Prevalence and the associated risk factors of HIV, STIs and HBV among men who have sex with men in Kunming, China. Int J STD AIDS2017; 28(11): 1115–1123.
47.
MinettiCRochaMDuqueLM, et al.Orogenital and anal infection by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and other sexually transmitted infections in men who have sex with men in Lisbon. Int J STD AIDS2024; 35(5): 379–388.
48.
ZuckerRGaisaMSigelK, et al.Triple site sexually transmitted infection testing as a crucial component of surveillance for men who have sex with men: a prospective cohort study. Int J STD AIDS2022; 33(2): 114–122.
49.
RosenbergerJGReeceMSchickV, et al.Sexual behaviors and situational characteristics of most recent male-partnered sexual event among gay and bisexually identified men in the United States. J Sex Med2011; 8(11): 3040–3050.
50.
ChowEPFVodstrcilLAWilliamsonDA, et al.Incidence and duration of incident oropharyngeal gonorrhoea and chlamydia infections among men who have sex with men: prospective cohort study. Sex Transm Infect2021; 97(6): 452–457.
51.
CornelisseVJWalkerSPhillipsT, et al.Risk factors for oropharyngeal gonorrhoea in men who have sex with men: an age-matched case-control study. Sex Transm Infect2018; 94(5): 359–364.
52.
AndoNMizushimaDTakanoM, et al.High prevalence of circulating dual-class resistant Mycoplasma genitalium in asymptomatic MSM in Tokyo, Japan. JAC Antimicrob Resist2021; 3(2): dlab091.
53.
ReadTRHMurrayGLDanielewskiJA, et al.Symptoms, sites, and significance of Mycoplasma genitalium in men who have sex with men. Emerg Infect Dis2019; 25(4): 719–727.
54.
NguyenKDAdamsonPCBuiHT, et al.Mycoplasma genitalium infections among participants in an HIV pre-exposure prophylaxis Program in Hanoi, Vietnam. Sex Transm Dis2024; 51(11): 750–755.
55.
LiPYuanTFitzpatrickT, et al.Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect2019; 95(6): 428–436.
56.
HassanABlumenthalJSDubeMP, et al.Effect of rectal douching/enema on rectal gonorrhoea and chlamydia among a cohort of men who have sex with men on HIV pre-exposure prophylaxis. Sex Transm Infect2018; 94(7): 508–514.
57.
Carballo-DiéguezABauermeisterJAVentuneacA, et al.The use of rectal douches among HIV-uninfected and infected men who have unprotected receptive anal intercourse: implications for rectal microbicides. AIDS Behav2008; 12(6): 860–866.
58.
LeeAGaitherTWLangstonME, et al.Lubrication practices and receptive anal sex: implications for STI transmission and prevention. Sex Med2021; 9(3): 100341.
59.
SchuettfortGGrohAKannG, et al.Sexually transmitted diseases in people living with HIV after implementation of cost coverage of HIV pre-exposure prophylaxis by statutory health insurance in Germany. HIV Med2023; 24(2): 163–169.
60.
LemmetTCotteLAllavenaC, et al.High syphilis prevalence and incidence in people living with HIV and Preexposure Prophylaxis users: a retrospective review in the French Dat'AIDS cohort. PLoS One2022; 17(5): e0268670.
61.
KenyonCOsbakKKApersL. Repeat syphilis is more likely to Be asymptomatic in HIV-infected individuals: a retrospective cohort analysis with important implications for screening. Open Forum Infect Dis2018; 5(6): ofy096.
62.
MalekinejadMBarkerEKMeraiR, et al.Risk of HIV acquisition among men who have sex with men infected with bacterial sexually transmitted infections: a systematic review and meta-analysis. Sex Transm Dis2021; 48(10): e138–e148.
63.
Le RouxMNgwenyaIKNemarudeAL, et al.Sexually transmitted infections and sexual behaviour among men having sex with men from Tshwane, South Africa. Int J STD AIDS2023; 34(3): 183–190.
World Health Organization. Bacterial Priority Pathogens List, 2024: bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. Geneva: World Health Organization, 2024. Licence: CC BY-NC-SA 3.0 IGO. https://iris.who.int/bitstream/handle/10665/376776/9789240093461-eng.pdf?sequence=1 (accessed date:10 March 2025).
66.
StockmanJHayashiHBarnesR, et al.Recent partner violence, sexual relationship power, and STIs among women who use methamphetamine: does type of sexual partner matter?J Urban Health2020; 97: 387–394.
67.
RotsaertASmekensTVuylstekeB, et al.Patterns of PrEP and condom use among PrEP users in Belgium: a web-based longitudinal study. BMC Public Health2023; 23: 970.
