LAUSR

One in 10 men receiving treatment for rectal chlamydia resume condomless receptive anal sex within a week of commencing treatment, potentially facilitating ongoing transmission to sexual partners. Supplemental digital content is available in the text. Background The resumption of sexual activity shortly after commencing treatment for sexually transmitted infections (STIs) is poorly described despite contributing to onward transmission. With azithromycin remaining an option for rectal Chlamydia trachomatis, resuming sex too early after treatment may contribute to antimicrobial resistance because of exposure of newly acquired STIs to subinhibitory concentrations. Methods Clinical and sexual behavioral data were collected from men participating in a trial assessing treatment efficacy for rectal chlamydia. Data were collected at recruitment and weekly for 3 weeks after commencing treatment. Outcome measures were resumption of any sexual activity or condomless receptive anal sex within 1, 2, or 3 weeks after commencing treatment. Generalized linear regression was used to calculate adjusted risk ratios (aRR) to identify associated factors. Results Almost 1 in 10 men (9.5%; 95% confidence interval [CI], 7.2–12.1) resumed condomless receptive anal sex within 1 week of commencing treatment. This was associated with current preexposure prophylaxis use (aRR, 3.4; 95% CI, 2.5–4.8]) and having 9 or more sexual partners in the last 3 months (aRR, 3.2; 95% CI, 1.6–5.0). Most men (75.0%; 95% CI, 71.3–78.5) resumed any sexual activity within 3 weeks; this was associated with a greater number of sexual partners (4–8 partners; aRR, 1.2; 95% CI, 1.1–1.5; ≥9 partners; aRR, 1.5; 95% CI, 1.3–1.7). Conclusions Resuming condomless receptive anal sex early after treatment may facilitate onward transmission and promote antimicrobial resistance for STIs. Although azithromycin remains a treatment option, this analysis highlights the need for new health promotion messages regarding early resumption of sex and continued surveillance for antimicrobial resistance.