Campylobacter spp. in men who have sex with men: A systematic review

Abstract

Objectives

Campylobacter spp. has been reported to be a sexually transmissible enteric infection in men who have sex with men (MSM) since the 1980s causing an acute severe diarrhoeal illness and rarely an acute demyelinating polyneuropathy (Guillain-Barré syndrome). The aim of this review was to explore the factors seen in MSM with Campylobacter spp.

Methods

We conducted a systematic review following PRISMA guidelines by searching 7 bibliographical databases in August 2024 for manuscripts in English. Initial screening was conducted by a primary author and then two authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts which explored factors seen in MSM with Campylobacter spp.. Two authors independently used the Joanna Briggs Institute critical appraisal tools to assess risk for bias. This review was registered with PROSPERO (CRD42023464803).

Results

25 manuscripts met the inclusion criteria that included 265 MSM with Campylobacter spp.. This review has highlighted demographic factors (living with HIV, living in urban MSM districts, HIV negative MSM using HIV-PrEP), biological factors (antimicrobial resistant Campylobacter spp., having a concurrent or previous sexually transmitted infection [Neisseria gonorrhoeae, Chlamydia trachomatis, Herpes simplex virus, Hepatitis C, Mpox] current/previous enteric infection including non-pathogenic parasites [Shigella spp., Giardia duodenalis, Cryptosporidium, Entamoeba histolytica, Salmonella spp., Entamoeba hartmanii, Entamoeba coli, Endolimax nana, Iodamoeba butchlii]) and behavioural factors (condomless receptive anal sex, oral-anal sex, oral genital sex, multiple/new sexual partners, using sex on premises venues and the internet to meet sexual partners) seen in MSM with Campylobacter spp.

Conclusion

This review has highlighted some important demographic, biological and behavioural risk factors seen in MSM with Campylobacter spp.. These data can be used to inform future public health interventions and clinical guidelines.

Keywords

sexually transmitted infection enteric infection men who have sex with men

Introduction

Campylobacter species are small Gram-negative motile bacteria and Campylobacter jejuni and Campylobacter coli are a common cause of diarrhoeal illness globally.¹ Campylobacter spp. can cause a spectrum of disease including acute procto-colitis, extra-intestinal disease such as cholecystitis, bacteraemia, abscess, meningitis and post infectious complications including an acute demyelinating polyneuropathy (Guillain Barre syndrome), a reactive arthritis and irritable bowel syndrome.¹ Campylobacter spp. are zoonotic and are transmitted from animals (e.g. poultry, cattle, pigs, sheep and domestic cats and dogs) to humans usually through the consumption of contaminated food and water or fingers with an estimated infective dose of 500–800 colony-forming units.^2,3 In high income settings, transmission of Campylobacter spp. is seen in returning travellers from endemic regions and local outbreaks from contaminated food or water. Campylobacter spp. generally cause a self-limiting illness with an incubation period of 2–5 days and symptomatic disease lasting around 7 days resolving without antimicrobial treatment.¹ Symptoms include diarrhoea, abdominal pain, fever, nausea and vomiting.¹ Campylobacter infections are generally mild but can be fatal in the extremes of age and immunosuppressed people.^1,4

Campylobacter infections in humans are usually sporadic; outbreaks are not often detected compared with other enteric pathogens.¹ In high income settings, campylobacteriosis manifests as bloody diarrhoea, and in lower income settings it presents as watery diarrhoea and is more frequently seen among children, which might provide natural immunity for people as adults. A variety of food including unpasteurized milk, poultry and other meats are associated with transmission in high income settings and person to person transmission has generally been low. However, more recently, similarly to other enteric pathogens, person to person transmission has been recognised amongst men who have sex with men (MSM) suggesting sexual transmission.

Sexually transmissible enteric pathogens were first described in MSM in the late 1960s.⁵ Sexually transmissible enteric infections in MSM can be caused by bacteria (Shigella spp. Campylobacter spp., diarrheagenic Escherichia coli, Salmonella spp.) and parasites (Giardia duodenalis, Entamoeba histolytica).⁶ There are significant concerns about the transmission of antimicrobial resistant sexually transmissible enteric bacteria including extensively resistant Shigella spp. in high income settings.⁷ Recent studies have demonstrated that circulating Campylobacter spp. is increasingly resistant to a broad range of antimicrobials such as fluroquinolones and macrolides.^8,9 Asymptomatic enteric pathogens in MSM may contribute to outbreaks and antimicrobial resistance including Campylobacter spp..¹⁰ Antimicrobial resistant campylobacteriosis, poses a major health risk and understanding the risk factors of Campylobacter spp. in MSM may provide insight for future public health control interventions, clinical guidelines and research. The aim of this study was to explore factors seen in MSM with Campylobacter spp. by systematically reviewing the published literature.

Methods

Search strategy and selection

A systematic review of the literature, using PRISMA guidelines was conducted in August 2024.¹¹ Seven bibliographical databases were searched (MEDLINE, EMBASE and EMCARE via combined search on OVID; CINAHL via the EBSCO platform; Global Health; Web of Science; and PUBMED) to identify relevant manuscripts using the following search terms (MSM OR men who have sex with men OR bisexual OR homosexual OR gay men) AND (Campylobacter OR enteric bacteria Or enteric pathogens OR Campylobacter jejuni OR Campylobacter coli OR Campylobacter infection OR Campylobacter spp.). Manuscripts meeting the following criteria were included in our review: participant identified as MSM, written in English language, peer-reviewed, primary data and at least one associated factor explored. Despite significant changes in societal views towards sex, sexuality and sexual health over the past 50 years we decided not to restrict publication by date but acknowledge that studies involving MSM with enteric infections 50 years ago may have very different parameters and research questions to modern day. Studies which did not include MSM or where participants were under the age of 16, were excluded. Where manuscripts contained mixed populations of MSM and other participants, only data from MSM was extracted and analysed. All types of study where primary data were reported were included, including case reports. Grey literature, opinion articles, review articles, editorials and conference abstracts were excluded.

Study selection and data extraction

Screening and selection of manuscripts for the final review occurred in a staged process. Each record from the initial search of citations was imported into EndNote software, and duplicate citations were removed. One primary author independently screened the citations and abstracts (NW). Full text manuscripts were then reviewed independently by two researchers (NW and VD) for eligibility. Cohen’s Kappa coefficient was calculated for inter-rater reliability.¹² Disagreements were resolved via discussion between the search team (NW, VD, CL & DR).

Quality assessment, risk of bias and data synthesis

Two authors (NW and VD) independently assessed quality and risk of bias using the Joanna Briggs Institute (JBI) critical appraisal checklist.¹³ Each manuscript was scored as having either a low, medium or high risk of bias. Disagreements were resolved by discussion between all authors. Narrative data was synthesised by populating a pre-determined table. The review protocol was pre-registered on the International Prospective Register of Systematic Reviews (PROSPERO reference: CRD42023464803).

Results

Five hundred and forty-eight manuscripts were identified from the initial search (Figure 1), 242 duplicate records were removed, 306 manuscript titles and abstracts were screened, and 116 manuscripts were removed. One manuscript was not available in any British library. One hundred and eighty-nine manuscripts were assessed against the eligibility criteria and 166 were removed. Two additional manuscripts were included from screening references (hand searching). (Figure 1) Twenty-five manuscripts published between 1980 and 2023 were included in this review.^4,14–37 (Table 1) The Cohen’s kappa score of 0.92 was calculated with a 98.4% agreement. The manuscripts were from USA (n = 9), Canada (n = 6), Nigeria (n = 2), Europe (n = 7) and Australia (n = 1). The study designs included case reports (n = 5), case series (n = 7), cohort studies (n = 3) and cross-sectional studies (n = 10). Sample sizes ranged from 1 to 235, with 265 MSM in total. We assessed the risk of bias as being medium in 11 manuscripts, and high in 14 manuscripts. (Supplementary Table 1).

Table 1.

Study design and risk factors seen in men who have sex with men (MSM) with Campylobacter spp..

Manuscript	Characteristics	Study design	Population	Risk factor seen in MSM with Campylobacter spp.
Quinn et al.,1980, USA¹⁴	22-year-old male presenting to Harbourview medical centre, Seattle	Case report	MSM: Symptomatic	Receptive anal sex
Quinn et al.,1980, USA¹⁴		Case report	MSM: Symptomatic	Oral-anal sex
Quinn et al., 1981, USA¹⁵	1/52 MSM presenting to Harbourview medical centre, Seattle	Cross-sectional	MSM: Symptomatic	Oral-anal sex
				Oral-genital sex
				Receptive anal sex
Devlin et al., 1983, Canada¹⁶	2 MSM aged 29 and 47 years presenting to Tropical diseases unit, Toronto hospital	Case series	MSM: Symptomatic	Concurrent infection with Giardia duodenalis, Entamoeba histolytica, Endolimax nana, Entamoeba hartmanii, Entamoeba coli
Devlin et al., 1983, Canada¹⁶		Case series	MSM: Symptomatic	Antimicrobial resistance (nalidixic acid)
Quinn et al 1994, USA¹⁷	10/158 symptomatic MSM and 2/75 asymptomatic MSM presenting to Harbourview medical centre, Seattle	Cross sectional	MSM symptomatic and asymptomatic	Oral-anal sex (p < .03)
Quinn et al 1994, USA¹⁷		Cross sectional	MSM symptomatic and asymptomatic	Concurrent Herpes simplex virus, Entamoeba histolytica, Shigella flexneri
Fennell et al., 1986, USA¹⁸	30-year-old MSM presenting to Harbourview medical centre, Seattle	Case report	MSM: Symptomatic	Receptive anal sex
Fennell et al., 1986, USA¹⁸		Case report	MSM: Symptomatic	3 casual sexual partners in the last month
Edmonds et al., 1987, USA¹⁹	2 MSM aged 37 and 45 years old	Case series	MSM: Symptomatic	Entamoeba histolytica
				Recent Shigella sonnei infection
				Antimicrobial resistance (Nalidixic acid)
Tee et al., 1988, Australia²⁰	HIV negative 35-year-old MSM presenting to fairfield infectious diseases hospital	Case report	MSM: Symptomatic	Previous Iodamoeba butchlii & Entamoeba coli infection
Tee et al., 1988, Australia²⁰		Case report	MSM: Symptomatic	Multiple male sexual partners
Laughon et al., 1988, USA²¹	27/378 MSM diagnosed with Campylobacter spp. from an HIV cohort study and HIV outpatients in Baltimore	Cross-sectional	MSM: 18/27 were asymptomatic	Living with HIV Previous Campylobacter spp. infection Concurrent Shigella, Neisseria gonorrhoeae, Chlamydia trachomatis & Herpes simplex virus
Laughon et al., 1988, USA²²	26/388 MSM with Campylobacter spp. from an HIV cohort study and HIV outpatients in Baltimore	Cross-sectional	MSM
Nelson et al., 1992, UK⁴	37 MSM living with HIV	Case series	MSM: Symptomatic	Living with HIV
Nelson et al., 1992, UK⁴	37 MSM living with HIV	Case series	MSM: Symptomatic	Co-infection with Cryptosporidium
Molina et al., 1995, France²³	28/38 MSM living with HIV	Cohort	MSM symptomatic	Living with HIV
				Antimicrobial resistance (Nalidixic acid, amoxicillin, Kanamycin, tetracycline, erythromycin, norfloxacin, ofloxacin, pefloxacin, ciprofloxacin)
				Co-infection with Giardia duodenalis, Cryptosporidium
Snijders et al., 1997, Netherlands²⁴	12 MSM (7 symptomatic, 5 asymptomatic)	Cross-sectional	Mixed: 12 MSM with Campylobacter spp. and 5 were asymptomatic	Living with HIV
	Mean age: 41 presenting to an HIV outpatient clinic in Amsterdam			Giardia duodenalis
				Antimicrobial resistance (tetracycline, ciprofloxacin, erythromycin)
Gaudreau et al., 2003, Canada²⁵	10 MSM with Campylobacter spp.	Case series	Mixed with 10 MSM: Symptomatic	Living in predominantly MSM district of Montreal
	10 MSM with Campylobacter spp.			Living with HIV
	Median age: 32 years presenting to the centre Hospitalier de l’Université de Montréal			Shigella sonnei, Giardia duodenalis, Entamoeba histolytica, Neisseria gonorrhoeae
				Antimicrobial resistance (erythromycin and ciprofloxacin)
				Oral-anal sex
Larsen et al., 2011, Denmark²⁶	77/141 MSM with Campylobacter spp.	Cohort	Mixed with 117 MSM: Symptomatic	Living with HIV
	Median age: 36 years			Salmonella spp.
	Patients at 8 specialised health care centres			Salmonella spp.
Gaudreau et al., 2013, Canada²⁷	17 MSM reported to Montreal public health department	Case series	Mixed with 17 MSM: Symptomatic	Living in Montreal’s ‘gay village’
				Living with HIV
				Having other sexually transmitted infections and Shigella flexneri
				Antimicrobial resistance (ciprofloxacin, nalidixic acid, tetracycline, and cefotaxime)
Gaudreau et al., 2015, Canada²⁸	31 MSM from hospital and public health laboratory records in Montreal (26 MSM living with HIV)	Case series	MSM: Symptomatic	Living with HIV
				Previous STIs (Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis)
				Antimicrobial resistance (erythromycin, azithromycin, clarithromycin, clindamycin, ciprofloxacin and nalidixic acid)
Nowak et al., 2017, Nigeria²⁹	Unknown/130 MSM living in Abuja, Nigeria	Cross-sectional	MSM: Unknown symptoms	Living with HIV
Marchand-Senécal et al., 2017, Montreal, Canada³⁰	12 MSM with Campylobacter spp.	Case series	Mixed with 12 MSM: Symptomatic	Living with HIV
	12 MSM with Campylobacter spp.			Antimicrobial resistance (ciprofloxacin, cefotaxime)
	Aged 40–69 years presenting to the centre Hospitalier de l’Université de Montréal			STIs (Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, Giardia duodenalis, Shigella spp., and hepatitis C) Sex on premises venues
				Using internet to meet sexual partners
Nowak et al., 2019, Nigeria³¹	Unknown/113 MSM living in Abuja, Nigeria	Cross-sectional	MSM: Unknown symptoms	Living with HIV
Nowak et al., 2019, Nigeria³¹	Unknown/113 MSM living in Abuja, Nigeria	Cross-sectional	MSM: Unknown symptoms	Condomless receptive anal sex
Newman et al., 2020, USA³²	27/235 MSM with Campylobacter spp. from diarrhoea samples from outpatient units in Seattle	Cohort	MSM: Unknown symptoms	Living with HIV
				HIV negative MSM using HIV pre-exposure prophylaxis
				Antimicrobial resistance (ciprofloxacin, erythromycin, doxycycline)
Greninger et al., 2020, USA & Canada³³	12/37 MSM, public health laboratory samples from Seattle & Montreal	Cross-sectional	Mixed with 12 MSM: Unknown symptoms	Antimicrobial resistance (fluoroquinolones and macrolides, gentamycin, and tetracycline)
Eke et al., 2021, USA³⁴	35-year-old male	Case report	MSM: Symptomatic	Living with HIV
Eke et al., 2021, USA³⁴	Living with well-controlled HIV presented to the emergency department	Case report	MSM: Symptomatic	Living with HIV
Raccagni AR et al. 2022, Italy³⁵	40 MSM living with HIV from cohort of 2406 diagnosed with bacterial enteric pathogen from HIV outpatient setting 2014–2022 (12 campylobacter)	Cross-sectional	MSM living with HIV	Living with HIV
Raccagni AR et al. 2022, Italy³⁵		Cross-sectional	MSM living with HIV	Antimicrobial resistance (fluoroquinolones tetracyclines, macrolides)
Raccagni AR et al 2022, Italy³⁶	42-year-old MSM using HIV-PrEP	Case report	MSM: Symptomatic	Using HIV-PrEP
				Co-infection with Mpox, Chlamydia trachomatis, Entamoeba histolytica
				Antimicrobial resistance (fluoroquinolones, tetracyclines, macrolides)
Mitchell et al., 2023, UK³⁸	207/2116 asymptomatic MSM with bacterial enteric pathogens including 35 who had Campylobacter spp.	Cross-sectional	MSM: Asymptomatic	(For any bacterial enteric pathogen)
				MSM living with HIV (aPR = 1.85, 95%CI = 1.25–2.75, p < .01)
	Patients at London sexual health clinic			Having a bacterial STI in past 12 months (p = .01)
	Patients at London sexual health clinic			Having 5–9 (aPR = 2.02, 95%CI = 1.29–3.16, p < .001) or >10 (aPR = 2.40, 95%CI = 1.51–3.80, p < .001) new sexual partners in past 3 months
STI = sexually transmitted infection, aPR adjusted prevalence ratio, MSM = men who have sex with men

Demographic factors

Residing in urban neighbourhoods with a greater proportion of MSM residing in Montreal’s ‘gay village’ or nearby was seen in MSM with Campylobacter spp. reported in two manuscripts.^25,27 Living with HIV was seen in MSM with Campylobacter spp. reported in 15 manuscripts.^{4,21–32,34,35,37} MSM using HIV-pre-exposure prophylaxis was seen in MSM with Campylobacter spp. reported in three manuscripts.^32,36,37 (Table 2).

Table 2.

Risk factors seen in MSM with Campylobacter spp.

Demographic	Living with HIV
	Living in a predominantly MSM district
	HIV negative MSM using HIV pre-exposure prophylaxis
Biological	Antimicrobial resistant Campylobacter spp
	Concurrent/previous sexually transmitted infection (Neisseria gonorrhoeae, Chlamydia trachomatis & Herpes simplex virus, hepatitis C, Mpox)
	Concurrent/previous enteric infection (Shigella spp., Giardia duodenalis, Cryptosporidium, Entamoeba histolytica, Salmonella spp.)
	Non-pathogenic parasites (Entamoeba hartmanii, Entamoeba coli, Endolimax nana, Iodamoeba butchlii)
Behavioural	Condomless, receptive anal sex
	Oral-anal sex (rimming)
	Oral-genital sex (fellatio)
	Multiple and/or new sexual partner(s)
	Using sex on premises venues to meet sexual partners
	Using internet to meet sexual partners

Biological factors

Having a concurrent, recent, or a previous sexually transmitted infection (STI) (e.g. Neisseria gonorrhoeae, Chlamydia trachomatis, Hepatitis C, Herpes simplex virus, Mpox) or enteric infection (Giardia duodenalis, Entamoeba histolytica, Shigella sonnei, Salmonella spp., Cryptosporidium) and non-pathogenic enteric organisms (Endolimax nana, Entamoeba hartmanii, Entamoeba coli, Iodamoeba butchlii and Entamoeba coli) were seen in MSM with Campylobacter spp. reported in 15 manuscripts.^{4,16,17,19–28,30,36,37} Antimicrobial resistant strains (to quinolones, tetracyclines, macrolides, clindamycin, penicillins/cephalosporins) was seen in MSM with Campylobacter spp. reported in 12 manuscripts.^{16,19,23–25,27,28,30,32,33,36}

Behavioural factors

Condomless receptive anal sex was reported in MSM with Campylobacter spp. in four manuscripts^14,15,18,31 Oral-anal sex, oral-genital sex and multiple male partners, was reported in MSM with Campylobacter spp. in six manuscripts^{14,15,17,20,25,37} Visiting sex on premises (‘gay bathhouses’ and ‘sex clubs’) and using the internet to find new sexual partners was reported in MSM with Campylobacter spp. in one manuscript.³⁰

Discussion

This is the first systematic review to explore factors seen in MSM with Campylobacter spp.. We have highlighted some demographic (living in urban MSM districts, HIV negative MSM using HIV pre-exposure prophylaxis), biological (living with HIV, antimicrobial resistance, having a concurrent/previous STI(s) [Neisseria gonorrhoeae, Chlamydia trachomatis, Herpes simplex virus, Hepatitis C] current/previous enteric infection including non-pathogenic parasites [Shigella spp., Giardia duodenalis, Cryptosporidium, Entamoeba histolytica, Salmonella spp., Entamoeba hartmanii, Entamoeba coli, Endolimax nana, Iodamoeba butchlii]) and behavioural (condomless receptive anal sex, oral-anal sex, oral genital sex, multiple/new sexual partners, using sex on premises venues and the internet to meet sexual partners) risk factors seen in MSM with Campylobacter spp. in MSM.

This review suggests that Campylobacter spp. is seen in MSM living in a ‘gay’ district (reported in two manuscripts).^25,27 This could suggest that Campylobacter spp. are circulating in discreet sexual networks of MSM residing in heavily populated urban areas. These discrete sexual networks of MSM may readily facilitate transmission of Campylobacter spp. similarly to circulating Shigella spp.³⁸ Social and sexual networks of MSM have previously been described as they represent important social connectivity, but also can facilitate the transmission of STIs including HIV.³⁹ Previous HIV surveillance studies suggest that cities such as Baltimore and Washington also had high rates of HIV transmission during these periods of Campylobacter spp. transmission.⁴⁰

Living with HIV was seen in MSM with Campylobacter spp..^{4,21–32,34,37} Individuals living with HIV and having a diarrhoeal illness are more likely to have Campylobacter spp. compared to HIV negative MSM.⁴¹ The association with HIV is similar to that seen with Shigella and diarrhoeagenic E. coli, and can be explained either by HIV immunosuppression, and increased susceptibility; or behavioural, as MSM living with HIV tend to be part of sexual networks with other MSM living with HIV (serosorting).^38,42–44 There is little evidence for increased susceptibility to enteric pathogens in MSM living with HIV as these patterns have disappeared with HIV-pre-exposure prophylaxis and other HIV control strategies.⁴⁵

The co-infection with STIs including other sexually transmissible enteric infections, and non or low pathogenic parasites demonstrate that Campylobacter spp. can co-circulate in sexual networks of MSM.^{4,16,19–28,30,37} The broad heterogeneity of enteric pathogens which can be detected in the gastrointestinal tract of MSM has been described in previous studies and show that even in asymptomatic MSM the parasite flora is more varied than in non-MSM.⁴⁶ MSM with Campylobacter spp. and other sexually transmissible enteric pathogens should be screened for STIs including HIV. It is curious that this review has not found that acute hepatitis A is seen in MSM with Campylobacter spp., and this may be due to vaccination and immunity levels in the populations studied.⁴⁷

It is of concern that antimicrobial resistant strains of Campylobacter spp. are circulating in MSM; increasing antimicrobial resistance is observed in bacterial STIs (N. gonorrhoeae, T. pallidum, M. genitalium) and other sexually transmissible enteric bacteria (S. flexneri, S. sonnei).^7,48,49 The consumption of antimicrobials has increased in asymptomatic MSM partly due to increased testing for C. trachomatis and N. gonorrhoeae using highly sensitive nucleic acid amplification tests in high income settings in MSM using HIV-PrEP.⁵⁰ Enteric pathogens have developed novel strategies for the transmission of antimicrobial resistance genes causing rapid transmission of antimicrobial resistance in sexual networks of MSM.⁵¹

This review has provided further evidence for the sexual transmission of Campylobacter spp. in MSM by highlighting that condomless receptive anal sex, oral-anal sex (rimming) and oral-genital (fellatio) was reported in MSM with Campylobacter spp.. Sexual behaviours in MSM can increase the risk of faecal contamination and transmission of faeco-oral pathogens.^38,52 The sexual behaviour repertoires in MSM and other minority groups for example oral-anal sex, coprophilia (scat play), meeting sexual partners in poorly lit settings such as sex on premises venues, where risk of faecal contamination may be increased may facilitate the transmission of enteric pathogens.⁵³ Seeking sex partners using the internet and social media has been described in other sexually transmissible enteric pathogens and likely represents frequent partner change, poor condom use, recreational drug use, serosorting and other factors which can increase the transmission of STIs.³⁸ Visiting sex on premises venues similarly facilitates the transmission of STIs in MSM and has the additional risk of faecal contamination during sexual behaviours compounded by poor handwashing opportunities.⁵⁴

There are several limitations to this systematic review including testing bias, publication bias and a considerable number of medium and high risk of bias manuscripts. There is significant reporting bias as none of the manuscripts are from lower- or middle-income settings and are predominantly from areas of high densities of MSM and academic institutions interested in the research of STIs and enteric pathogens in MSM. The manuscripts in this review were heterogenous including 11 case reports and case series which have inherent methodological weakness as they cannot control for confounders. The collection of data and factors was highly varied and mainly relied on clinical records rather than prospective collection. Not all MSM with a diarrhoeal illness will present to healthcare for testing or offer information on their sexual behaviour. It is unclear whether manuscripts contained data regarding gender diverse people, despite the possibility of similar transmission routes.⁵³

This systematic review has highlighted some important demographic, biological and behavioural risk factors seen in MSM with Campylobacter spp. which can be used to inform future strategies and research for controlling the transmission of Campylobacter spp. in MSM. For example, outbreak control could target the MSM profile detailed in this review including behavioural, location (sex on premises venues, ‘gay’ neighbourhood) or MSM diagnosed with other infections. More work is needed on the transmission dynamics, surveillance, diagnostics and public health control of Campylobacter spp. to prevent future outbreaks, increasing antimicrobial resistance and severe illness. Clinicians managing MSM with Campylobacter spp. should consider screening for other STIs and careful judgement around antimicrobial use.⁶ Furthermore, Campylobacter should be considered and appropriately tested for in MSM with gastrointestinal symptoms.

Supplemental Material

Supplemental Material - Campylobacter spp. in men who have sex with men: A systematic review

Supplemental Material for Campylobacter spp. in men who have sex with men: A systematic review by Natasha Wahab, Vaibhav Dubey, Vidhushan Sivachandran, Carrie Llewellyn and Daniel Richardson in International Journal of STD & AIDS.

Footnotes

Acknowledgements

We would like to acknowledge Annemarie Frank and colleagues associated with Brighton and Sussex Medical School Libraries.

Author Contributions

DR developed the study concept, NW, CL and DR designed the study protocol, NW conducted the data search and initial citation and abstract reviews, NW, VD independently reviewed the manuscripts eligibility, with CDL and DR as third reviewers for any discrepancies. NW and VD conducted the risk of bias assessment, NW and DR conducted the data analysis and synthesis, NW produced the first draft and NW, VD, VS, CL and DR all contributed to the final manuscript.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical statement

ORCID iDs

Carrie Llewellyn

Daniel Richardson

Data availability statement

Data sharing not applicable to this article as no new data were generated.

Supplemental Material

Supplemental material for this article is available online.

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