Extended spectrum β-lactamase Enterobacteriaceae (ESBL-E) might be sexually transmitted. Men who have sex with men (MSM) have different sexual behavior than the general population and thus might be at risk for ESBL-E carriage. We determined the prevalence of ESBL-E carriage and its association with sexual behavior among MSM in Amsterdam, the Netherlands.
We screened 583 HIV-positive and HIV-negative MSM of the Amsterdam Cohort Study for rectal ESBL-E carriage between April-December 2018. Participants completed a self-administered questionnaire on (sexual) behavior and risk factors for antibiotic resistance. The proportion with ESBL-E carriage was compared by number of sex partners using logistic regression and across clusters of sexual behaviors with steady and casual partners, separately, using latent class analyses; all adjusted for recent antibiotic use, travel and hospitalization.
16.3% (95%-confidence interval (95%CI)=13.4-19.5) tested ESBL-E positive. The odds of ESBL-E carriage increased as number of sexual partners increased (adjusted odds ratio per ln(partner+1), 1.57, 95%CI=1.26-1.94; p<0.001). There was no association between ESBL-E carriage and sexual behavior with steady partners. Compared to participants in the 'no sex with casual partner' cluster, adjusted odds of being ESBL-E positive were 2.95-fold higher (95%CI=1.52-5.80) for participants in the 'rimming and frottage' cluster (p=0.001) and 2.28-fold higher (95%CI=0.98-5.31) for participants in the 'toy use and fisting' cluster (p=0.056).
ESBL-E prevalence in MSM is higher than the overall Dutch population, likely due to sexual transmission with casual partners. This implies that sexually-active MSM should be considered a risk group for ESBL-E carriage.

Copyright © 2021. Published by Elsevier Ltd.

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