Sexual behaviors and risk of extended-spectrum β-lactamase-producing Enterobacterales carriage: A cross-sectional analysis

Objectives: Sexual transmission of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) is suspected. We aimed to identify clusters of sexual behavior associated with ESBL-E carriage among individuals at risk of sexually transmitted infections (STI). Methods: In this cross-sectional study, patients attending an STI-screening center and human immunodeficiency virus outpatient clinic in Paris, France between 2018 and 2019 were asked questions on the following sexual activities in the last 6 months: receptive/insertive anal intercourse, passive/active rimming, receptive/insertive fellatio, receptive/insertive fisting, receptive/insertive fingering, active/passive cunnilingus. ESBL-E carriage was determined from rectal swabs. Bayesian latent class analysis was used to identify clusters of sexual activity, which were then associated with ESBL-E carriage using logistic regression. Results: Among 1211 men who have sex with men (MSM), those belonging to two latent classes with higher prevalence of insertive fingering and active rimming (ESBL-E prevalence = 15.3%, N = 124 and 16.0%, N = 100) and one class with higher proportions of all behaviors (24.3%, N = 70) had a higher risk of ESBL-E carriage compared to those in a class with few sexual behaviors (7.3%, N = 259) after adjustment. Among 439 other men and 479 women, no clear associations between sexual clusters and ESBL-E carriage were observed. Conclusions: Sexual behaviors are associated with varying degrees of ESBL-E carriage, particularly among MSM. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)