Proton pump inhibitors (PPIs) and sexually transmissible enteric infections in men who have sex with men: PPI-stewardship

Faeco-oral pathogens are sexually transmissible in men who have sex with men (MSM).1 2 Gastric acid suppressants including proton pump inhibitors (PPIs) are used to treat acid reflux and gastric ulcers but can increase the risk of enteric infections.3 PPIs reduce gastric acid secretion, which can increase bacterial survival into the intestine and can alter the composition of intestinal microbiota, affecting microbiota-mediated resistance.3 PPIs are also associated with C. difficile, gastric cancer and renal disease.3 A recent analysis of 375 MSM in Taiwan demonstrated that recent use of PPIs was associated with asymptomatic carriage of enteric pathogens (Giardiaduodenalis, Entamoeba histolytica, Shigella spp., p<0.001).1 Asymptomatic carriage of enteric bacteria contributes to the emergence and transmission of extensively drug-resistant Shigella (and possibly Campylobacter spp., E. coli, Salmonella spp.).2

Some groups of MSM have high rates of alcohol, smoking and…

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