Good sex, bad sex, chem sex

Adam Bourne (La Trobe University, Melbourne) defined “chem sex” as recreational drugs, (usually crystal meth, methedrone, GHB , GBL, or ketamine) taken immediately before and/or during sex between men. It is facilitated by sexual networking apps and SOP venues. In his study of MSM: 6.6% had used in the previous 4/52 but 21.95 of HIV+ve  men. The figure rose to 32.7% in London.

The figures varied from 5-15% in a European MSM internet survey. Participating in chem sex was strongly associated with previous drug use, STI, PEP use and group sex. It came with an increased risk of UAI and new partners. It may be used to overcome a reduced libido but once indulged can lead to difficulty in enjoying “sober”sex.

Dominic Rowley (consultant in sexual health and HIV medicine at The GUIDE Clinic at St James’s Hospital in Dublin) talked about emerging STI’s and resistance:

50% of HIV diagnosis in 2014 were late presenters and synergy with STI’s is well known. For example the presence of urethritis is associated with an 8 fold increase in vRNA. He reviewed the state of play of STI’s:

NG 80,000 in Europe 2015. MSM majority and increasing. Ceftriaxone resistance emerged in Japan in 2012 and is a great concern.

CT 350000, and commoner in heterosexual population. There is a 10% failure oral infection clearance with azithromycin when compared to 2% with doxycycline. It has been suggested that a single dose of  azithromycin may not be enough. He recommended a test for cure in all patients or to use doxycycline 100mg BD for 1/52. He highlighted the anomaly of not performing anal/throat swabs in heterosexual females despite the knowledge that UAI/oral sex is common.

MG he referred to the Melbourne study recommending an initial 1/52 doxycycline course followed by azith or moxifloxacin.

Syph increasing incidence and increasing macrolide resistance

Shigella  emerging as an STI associated with oro/anal contact like HepA

LGV increasing incidence in Europe

Luisa Salazar-Vizcaya (Postdoctoral researcher; Inselspital, Bern University Hospital, University of Bern ) looked at nsCAI (condomless AI with non steady partner) in MSM. she found a general increase over the past 10yrs. She described 4 behavioural clusters and postulated that awareness of reduced HIV transmission with ART, and awareness/availability of PrEP had led to this finding.

David Zucman (Internal Medicine, Hopital Foch, Suresnes, France) reported a recent Hepatitis A outbreak in MSM , the largest in history and an emerging worldwide problem. There is now a worldwide shortage of HepA vaccine as well as HepB which I was unaware of; I suggest ordering supplies immediately! He found that although 76% of HIV +ve were immune only 39% of HIV-ve were.

David Stuart (ChemSex support programmes at 56 Dean Street sexual health clinic in London) and David Atefi (Atlanta Gastroenterology Associates) described the provision of chem-sex support at the Dean St Clinic in London. This has been running since 2011 as a walk-in clinic. They see 40-50 clients/week. His study showed significantly higher rates of STI/HIV testing rates and self-reported improvement in  confidence in managing their chem use and risk taking behaviour.

Teymur Noori (European Centre for Disease Prevention and Control Solna, Sweden) reported from the Hornet/ECDC study showing attitudes to take up of PrEP. 17 questions were presented in 8 languages via the Hornet MSM app. They had 12,053 responders of which 11%HIV+ve. 10% were using PrEP of which 50% was from a doctor but 50% was informal supply. 31% had not informed their health provider. 

Of those taking PrEP, 50% had also taken PEP, were more likely to be  tested for, and diagnosed with STI’s. They also reported greater happiness with their sex life!

Valentina Cambiano (Research Associate in the Department of Infection & Population Health at the Institute of Epidemiology & Health Care at University College London) presented some results from the aurah2 study. This study was conducted in three sexual health clinics in U.K. Between 2013-2017. 668 completed annual questionnaires. She found increased PrEP awareness from 43-92% in the period and 23% rate of use. she made the point  that these clinics had  taken part in the PROUD study and that awareness may have been higher. I was also surprised at the 85%+ caucasian / 75% tertiary educated demographic which I thought underrepresented the lower SE classes in London particularly.

Overall this was a very interesting session although, as one of the chairs mentioned: no one had addressed the definition of “bad sex!”