SCREENING FOR ASYMPTOMATIC STDS AND STAPHYLOCOCCUS CARRIAGE IN HIV INFECTED MEN

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Sexually transmitted diseases (STDs) have been shown to be increasing, particularly in men who have sex with men (MSM). The presence of STDs correlates with unsafe sexual practices in the community and can contribute to HIV transmission. Moreover, there is an increasing frequency of asymptomatic infections with gonorrhea and Chlamydia. Consequently, recent Centers of Disease Control and Prevention (CDC) STD guidelines recommend assessment of sexual risk, client centered prevention, and STD screening to include testing of urethral, pharyngeal and rectal sites in at-risk MSM. It is suggested that screening be performed at least annually, and more frequently in those considered to be at the highest risk. Since there are few data regarding how to define the optimal frequency for screening and what group constitutes those at the highest risk, the guidelines are primarily on expert opinion. Our study will explore these issues by studying HIV-infected MSM over time to determine how often new cases of asymptomatic infection are identified and whether there are select groups whose behaviors predict that they are at the greatest risk for STDs. To assess the risk for HIV transmission in asymptomatic STDs, we will measure the HIV load in genital secretion in patients with asymptomatic STD before and after therapy. The second part of the study will focus on asymptomatic colonization of Methicillin resistant Staphylococcus aureaus (MRSA) colonization in the nasal cavity. Recently there have been increases locally and nationally of antibiotic (methicillin)-resistant Staphylococcus aureus (MRSA) infections among men who have sex with men. These MRSA infections appear to be possibly more serious and contagious than typical S. aureus infections. Additionally, there ar edata suggesting that transmission from person to person among MSM occurs in a similar fashion to sexually transmitted diseases. It is suspected that Staphylococcus aureus (S. aureus) and MRSA infections occur after nasal colonization with S. aureus established. However, little is known about the persistence of S. aureus colonization in the nose. To better understand the prevalence of S. aureus and MRSA nasal colonization among MSM, its acquisition and its persistence, we will perform a longitudinal survey of nasal colonization with S. aureus in noses of patients. At each study visit, participants will undergo nasal swabbing of both nostrils and these swabs will be tested for the presence of S. aureus bacteria and the presence of drug-resistant S. aureus/MRSA. Additionally, these S. aureus isolates will be tested for strain type to see if the strains colonizing a patient persist in the same patient or are replaced with other S. aureus strains and to understand the relatedness of the local strains of S. aureus among different persons. Additionally, we will ask the participants to donate blood and serum samples for future testing. The field of infections is developing rapidly. Newly recognized pathogens are likely to be discovered as well as known pathogen will become clinically significant in the future. Stored blood and serum sample from participants of this longitudinal study will be very valuable in the future to answer questions regarding prevalence and incidence of potential new infections.