Men Who Have Sex With Men: Sexual Behavior May Not Represent an Increased Risk for Methicillin-Resistant Staphylococcus aureus Colonization

Men Who Have Sex With Men: Sexual Behavior May Not Represent an Increased Risk for Methicillin-Resistant Staphylococcus aureus Colonization | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Men Who Have Sex With Men: Sexual Behavior May Not Represent an Increased Risk for Methicillin-Resistant Staphylococcus aureus Colonization Bruno de Christo Felicidade, Mayara Rodrigues Bicca, Eduarda Oliveira Pinto, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8492252/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Colonization by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging public health concern, particularly in groups traditionally considered at elevated risk, such as men who have sex with men (MSM). Despite this, the local epidemiology and behavioral determinants of CA-MRSA colonization in non-metropolitan regions remain insufficiently examined. This cross-sectional study assessed the prevalence of nasal colonization by CA-MRSA and methicillin-resistant coagulase-negative Staphylococci (MRCoNS) in a sample of 89 men (44 MSM and 45 heterosexual) from the central region of Rio Grande do Sul, Brazil. Nasal swabs were collected for microbiological culture, antimicrobial susceptibility testing, and molecular detection of the mecA and nuc genes through qPCR. Participants completed a self-administered questionnaire addressing sociodemographic information, sexual behaviors, and hygiene practices. Results showed a CA-MRSA prevalence of 20% among heterosexual men and 6.8% among MSM. Heterosexual orientation was identified as a significant risk factor (OR = 5.12; p = 0.021), whereas identifying as MSM appeared to be protective (OR = 0.20; p = 0.021). Post-coital hygiene—specifically showering after sexual intercourse—was also found to be an independent protective factor (OR = 0.16; p = 0.026). These findings challenge the conventional assumption that MSM universally constitute a high-risk group for CA-MRSA colonization. Instead, the higher prevalence detected among heterosexual men in this setting seems linked to individual hygiene behaviors, underscoring the relevance of universal preventive strategies emphasizing post-sex hygiene rather than approaches based solely on sexual orientation. Microbiota Multidrug resistance Public Health CA-MRSA homossexuality Figures Figure 1 INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is a high-priority pathogen due to its high prevalence, especially in first-world countries such as the USA and Europe, where the pathogen is one of the most prevalent, representing a significant global risk. According to Lemon ( 2020 ), at least 10,000 individuals died in the USA from MRSA infections. Among its main risk elements is the USA300 clone, a particularly virulent and resistant strain of MRSA, which has spread widely in the community, increasing the risk of this pathogen (Augusto et al., 2022 ). With the significant growth in MRSA infections, it has become increasingly common to find healthy individuals colonized by the bacteria, even without a recent history of hospitalization or contact with healthcare institutions. Although such individuals have no risk factors previously linked to infection, this has highlighted the spread of MRSA beyond the hospital setting. This growth has presented an extra challenge, as community-associated MRSA (CA-MRSA) has shown a reduced response to commonly used antibiotics, increasing its incidence in various population groups (Galindo et al., 2012 ). Among the different population groups affected by CA-MRSA, the LGBTQIAPN+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Pansexual) community stands out, a community that has historically been associated with concepts such as sexually transmitted infections (STIs) and chemsex. It should be noted that homosexuality was only removed from the Diagnostic and Statistical Manual of Disorders (DSM-III-R) in 1990, while transsexuality was only declassified as a mental disorder in 2018, when the DSM-5 was updated (American Psychiatric Association, 1987 ; 2018 ). As CA-MRSA has become known, it is more frequent in different social groups, including cisgender men who are homosexual, bisexual, and/or men who have sex with other men (MSM), who face daily inequalities in relation to sexual health compared to heterosexual cisgender individuals (Gerymski and Magoń, 2023 ). The impact of CA-MRSA on these individuals not only poses a risk to their physical but also to their mental health, involving not only bacterial colonization but also the discrimination and stigma that these individuals face daily, which can significantly increase the prevalence of mental disorders, such as anxiety and depression, among others (WHO, 2017). The need for integrated care that considers the physical and mental health of the LGBTQIAPN + community is reinforced by the correlation between risk factors, such as illicit drug use, anonymous sex and contact with people who have skin infections can be considered risk actions for MSM (Szumowski et al., 2009 ). Issues such as skin and soft tissue infections and abscesses are recurrent among those infected with CA-MRSA. Also, although less recurrent, CA-MRSA can lead to more serious infections, such as pneumonia, endocarditis, and osteomyelitis. In addition, the possible link between CA-MRSA and MSM can negatively affect the mental health and quality of life of these individuals, especially in a community that has suffered and still suffers from many prejudices (Lee et al., 2005 ). Although the specific connection that exists between MRSA and the cisgender gay, bisexual, and/or MSM community is still unexplored. Seeking to develop and promote culturally competent prevention and care strategies adapted to the specific needs of the MSM population, presenting methods to prevent and treat infectious diseases that affect this community, and providing this population with culturally appropriate health care, we aimed to collect epidemiological data on CA-MRSA nasal colonization in MSM individuals living in the municipality of Santa Maria, RS, Brazil, also in a way to verify if there is a link between sexual behavior and colonization/infection by this pathogen. MATERIAL AND METHODS Ethics The present study is cross-sectional, with a quantitative and analytical nature, conducted to determine the prevalence of CA-MRSA/MRCoNS colonization and identify the association of demographic and behavioral risk factors in the study population through data collection performed at a single point in time. The study was approved by the Universidade Franciscana Research Ethics Committee (N. 7.265.473). All participants were over 18 years old and signed a free and informed consent form (FICF) before taking part in the research, in accordance with the ethical guidelines for studies with human beings. Sampling A convenience sampling approach was employed, involving men assisted at the Specialized Assistance Service (SAE) and the Testing and Counselling Centre (CTA) in Santa Maria, Rio Grande do Sul, Brazil. From an estimated reference population of 975 to 1,050 individuals attended during this period, a sample of 100 participants was recruited, yielding a 9.3% margin of error with a 95% confidence level. The study was conducted between May and August 2025 and involved two stages of collection: (1) a self-administered questionnaire containing sociodemographic data (age, educational level, marital status, and sexual orientation), clinical data (comorbidities, history of infections, hospitalization, antibiotic use, and HIV status), and behavioral data (sexual practices, hygiene habits, substance use, physical activity, and social exposure) and (2) nasal swab collection. All data were treated confidentially and anonymously. The inclusion criteria were: (1) male individuals aged 18 years or older; (2) those who sought care or assistance at the SAE or CTA in Santa Maria during the study period; and (3) individuals who self-identified as men who have sex with men (MSM) or cisgender heterosexual men. The exclusion criteria were: (1) recent antibiotic use; (2) presence of chronic diseases; and (3) individuals who did not identify with either of the sexual orientation categories considered in the study. Individuals who did not provide information on sexual orientation ( n = 9) or who did not meet the group categorization criteria ( n = 2) were excluded from the final analysis, and no methods for imputing missing data were applied. Microbiological characterization Nasal samples were collected in Stuart swabs (Laborclin ® ) from the study participants and immediately transported at room temperature to the Molecular Microbiology Research Laboratory (LaPeMM) for processing. Swabs were inoculated in Brain Heart Infusion (BHI, Himedia®) broth and incubated at 37°C for a period of 18 to 24 hours. After enrichment, aliquots of each culture were sown on Blood Agar and Mannitol Salt Agar (Himedia®) supplemented with oxacillin (4 µg/mL). After incubation, colonial morphology was assessed by Gram staining and confirmation by biochemical tests (Laborclin ® ). The confirmed isolates of S. aureus were submitted to the evaluation of the antimicrobial susceptibility profile by Kirby-Bauer (1966) disk-diffusion method, using Mueller-Hinton Agar and following the BrCAST 2025 guidelines, for levofloxacin, gentamicin, amikacin, erythromycin, cefoxitin, sulfamethoxazole-trimethoprim, penicillin, linezolid, rifampicin, and tetracycline. Isolates presenting resistance to cefoxitin were classified as methicillin-resistant and considered presumptive of MRSA (CLSI, 2024 ). Molecular characterization Genomic DNA was extracted from MRSA isolates using a commercial kit (manufacturer) following the manufacturer's protocol. PCR reactions were carried out to detect the mecA gene, responsible for methicillin resistance, with the primers mecA-F (5'- AAA GAA CCT CTG CTC AAC AAG T-3'), mecA-R (5'- TGT TAT TTA ACC CAA TCA TTG CTG TT-3'), nuc-F GAA TGT CAT TGG TTG ACC TTT GTA and nuc- R AAA TTA CAT AAA GAA CCT GCG ACA (Thomas et al., 2007 ). The amplification was carried out at QuantStudio™ 5 Real-Time PCR (Thermo Fisher Scientific) using SYBR™ Green qPCR Master Mix (Thermo Fisher Scientific) in a 10 µL reaction volume. Statistical Analysis Quantitative data were analyzed using SPSS software (version 25.0) for all statistical calculations. Continuous variables were categorized according to predefined questionnaire categories or epidemiologically relevant cut-off points. The Gemini artificial intelligence tool was used exclusively for data organization and formatting to facilitate readability and was not involved in statistical testing. P -values were calculated using Fisher’s Exact Test (two-sided); Odds Ratios (OR) and their 95% Confidence Intervals (CI) were determined, with a significance level set at p < 0.05. Multivariate analysis was not performed due to the limited number of positive outcomes ( n = 15). Given the exploratory nature of the study and the sample size, univariate analysis using Fisher’s Exact Test and Odds Ratios was considered the most appropriate approach to minimize overfitting. This study was reported in accordance with the STROBE guidelines for observational studies. RESULTS The study analyzed 44 MSM (9 bisexual and 35 homosexual) and 45 cisgender heterosexual men's nasal samples. A total of 11 individuals were not analyzed by the study, where 9 preferred not to answer about their sexual orientation, 1 had another sexual orientation that was not covered in the questionnaire, and 1 was transsexual. For the MSM group, 6 strains of S. aureus showed resistance to FOX, with 3 strains (6.8%) confirmed as CA-MRSA by qPCR analysis. For the heterosexual group, we isolated 13 strains of S. aureus resistant to FOX, with 9 strains (20%) confirmed as CA-MRSA. Another 3 strains (6.6%) of coagulase-negative Staphylococci (CoNS) isolated in the heterosexual group showed resistance to FOX (MRCoNS) and were confirmed to be carrying the mecA gene (Fig. 1 and Table 1 ). `Antimicrobial susceptibility testing performed on S. aureus isolates revealed varied resistance profiles among the samples (Table 1 ). The results show a predominance of resistance to FOX and RIF across the S. aureus and CoNS isolates, with several isolates displaying variable susceptibility to other agents such as CLI, GEN, and TET. The presence of mecA gene was confirmed in all tested samples, indicating a potential for methicillin resistance. Variations in susceptibility were also identified for other classes of antimicrobials, such as fluoroquinolones, macrolides, aminoglycosides, and rifamycins, indicating the presence of genetically diverse isolates among the analyzed samples, according to BrCAST (2025) guidelines. These findings demonstrate the epidemiological relevance of resistant strains of S. aureus spread in community settings and suggest potential challenges for the control and treatment of such infections. Table 1. Antimicrobial profile for the MRSA strains obtained from MSM and heterosexual groups. After microbiological characterization and antimicrobial susceptibility profiling, possible behavioral and demographic factors associated with nasal colonization by MRSA/MRCoNS were analyzed using a questionnaire aimed at identifying potential predictors of its colonization among the participants. Although most variables did not show statistically significant associations, some factors demonstrated relevant trends (Table 2 ). Table 2 Comparison of sociodemographic and behavioral factors between mrsa/mrcons positive and negative groups. Variable / Factor MRSA/MRCoNS Positive (n = 15) MRSA/MRCoNS Negative (n = 73) P Value OR (95% CI) SEXUAL ORIENTATION Heterosexual 12 (80.0%) 32 (43.8%) 0.021 5.12 (1.33–19.71) MSM (Homosexual/Bisexual) 3 (20.0%) 41 (56.2%) 0.021 0.20 (0.05–0.75) ETHNICITY White 11 (73.3%) 48 (65.8%) 0.765 1.43 (0.41–4.96) Black / Mixed 3 (20.0%) 24 (32.9%) 0.378 0.51 (0.13–1.98) AGE GROUP 18–30 Years 4 (26.7%) 21 (28.8%) 1.000 0.90 (0.26–3.15) 30–40 Years 2 (13.3%) 20 (27.4%) 0.338 0.41 (0.08–1.97) 40–50 Years 3 (20.0%) 20 (27.4%) 0.750 0.66 (0.17–2.60) > 50 Years 6 (40.0%) 12 (16.4%) 0.072 3.39 (1.02–11.30) EDUCATION LEVEL High School 9 (60.0%) 28 (38.4%) 0.155 2.41 (0.77–7.50) Higher Education 2 (13.3%) 27 (37.0%) 0.129 0.26 (0.05–1.25) MARITAL STATUS Single 10 (66.7%) 54 (74.0%) 0.542 0.70 (0.21–2.32) Married 3 (20.0%) 15 (20.5%) 1.000 0.97 (0.24–3.87) CLINICAL HISTORY History of Infection 12 (80.0%) 58 (79.5%) 1.000 1.03 (0.26–4.14) Hospitalization (last 12m) 5 (33.3%) 13 (17.8%) 0.179 2.31 (0.67–7.89) Antibiotic Use (last 3m) 5 (33.3%) 33 (45.2%) 0.568 0.61 (0.19–1.95) HABITS & HYGIENE Showering after sex 11 (73.3%) 69 (94.5%) 0.026 0.16 (0.03–0.73) Tattoos 9 (60.0%) 51 (69.9%) 0.545 0.65 (0.21–2.04) Recent Tattoo (last 6m) 2 (13.3%) 5 (6.8%) 0.341 2.09 (0.37–11.97) Regular Sports Practice 6 (40.0%) 35 (47.9%) 0.777 0.72 (0.23–2.24) Sharing Clothes 1 (6.7%) 5 (6.8%) 1.000 0.97 (0.11–8.97) RISK BEHAVIORS Unprotected Sex 2 (13.3%) 30 (41.1%) 0.074 0.22 (0.05–1.05) Sex Club / Swing 1 (6.7%) 4 (5.5%) 1.000 1.23 (0.13–11.87) Treated for STI (non-HIV) 2 (13.3%) 16 (21.9%) 0.726 0.55 (0.11–2.68) HIV STATUS HIV Positive 10 (66.7%) 42 (57.5%) 0.576 1.48 (0.46–4.75) SEXUAL BEHAVIOR (LAST 3 MONTHS) Sexual partners (1 to 2) 9 (60.0%) 50 (68.5%) 0.555 0.69 (0.22–2.17) Sexual partners (3 to 4) 0 (0.0%) 5 (6.8%) 0.583 0.00 (0.00–7.65) Sexual partners (> 4) 1 (6.7%) 6 (8.2%) 1.000 0.80 (0.09–7.16) Unprotected sex 3 (20.0%) 29 (39.7%) 0.238 0.38 (0.10–1.46) Multiple partners 1 (6.7%) 11 (15.1%) 0.682 0.40 (0.05–3.38) Group sex 0 (0.0%) 3 (4.1%) 1.000 0.00 (0.00–13.2) ITEMS SHARED WITH PARTNER Towels (with partner) 5 (33.3%) 31 (42.5%) 0.576 0.68 (0.21–2.18) Personal hygiene products 4 (26.7%) 27 (37.0%) 0.560 0.62 (0.18–2.14) Sex toys 2 (13.3%) 8 (11.0%) 0.677 1.25 (0.24–6.57) Razors / Shaving equipment 0 (0.0%) 8 (11.0%) 0.342 0.00 (0.00–4.54) Clothing / Personal garments 0 (0.0%) 4 (5.5%) 1.000 0.00 (0.00–9.74) HABITS & LIFESTYLE Illicit substance use 3 (20.0%) 14 (19.2%) 1.000 1.05 (0.26–4.24) Nail biting (Onychophagia) 4 (26.7%) 27 (37.0%) 0.560 0.62 (0.18–2.14) Regular sports practice 6 (40.0%) 31 (42.5%) 1.000 0.90 (0.29–2.80) Travel abroad 0 (0.0%) 10 (13.7%) 0.200 0.00 (0.00–3.51) Habit of reading/researching 7 (46.7%) 43 (58.9%) 0.406 0.61 (0.20–1.86) LIVING SITUATION Lives with sexual partner 5 (33.3%) 30 (41.1%) 0.773 0.72 (0.22–2.31) Lives with other(s) 4 (26.7%) 14 (19.2%) 0.498 1.53 (0.42–5.53) Lives alone 6 (40.0%) 30 (41.1%) 1.000 0.96 (0.31–2.97) SHARED EQUIPMENT & ENVIRONMENTS Gym equipment 3 (20.0%) 20 (27.4%) 0.750 0.66 (0.17–2.60) Attended gym 2 (13.3%) 19 (26.0%) 0.506 0.44 (0.09–2.12) Shared towels (General) 1 (6.7%) 7 (9.6%) 1.000 0.67 (0.08–5.92) Sauna and showers 1 (6.7%) 2 (2.7%) 0.433 2.54 (0.21–29.9) Joined sports team 1 (6.7%) 5 (6.8%) 1.000 0.97 (0.11–8.97) Shared clothes/uniforms 1 (6.7%) 4 (5.5%) 1.000 1.23 (0.13–11.9) CLINICAL & PSYCHOSOCIAL HISTORY Psychological/Psychiatric counseling 3 (20.0%) 20 (27.4%) 0.750 0.66 (0.17–2.60) Has support network 4 (26.7%) 29 (39.7%) 0.395 0.55 (0.16–1.90) Recent imprisonment 1 (6.7%) 5 (6.8%) 1.000 0.97 (0.11–8.97) Hospitalization (last 12m) 1 (6.7%) 9 (12.3%) 1.000 0.51 (0.06–4.34) Treated for skin infection 1 (6.7%) 5 (6.8%) 1.000 0.97 (0.11–8.97) Part of social movement 0 (0.0%) 11 (15.1%) 0.199 0.00 (0.00–3.14) The comparative analysis between participants with CA-MRSA/MRCoNS colonization ( n = 15) and the negative control group ( n = 73) revealed statistically significant associations regarding variables related to sexual orientation and hygiene habits. Concerning sociodemographic characteristics, sexual orientation proved to be a relevant discriminating factor. Identifying as heterosexual presented as a significant risk factor for colonization, with a likelihood of occurrence more than five times higher compared to other groups (OR = 5.12; 95% CI: 1.33–19.71; ). Conversely, the group of Men who have Sex with Men (MSM) revealed an inverse association, suggesting a protective effect or lower prevalence in this specific sample (OR = 0.20; 95% CI: 0.05–0.75; p = 0.021). Regarding hygiene habits and lifestyle, showering after sexual intercourse stood out as a statistically significant variable, associated with a marked reduction in the probability of positive colonization (OR = 0.16; 95% CI: 0.03–0.73; p = 0.026). Other behaviors, such as unprotected sex, showed a trend towards a negative association, although not significant (OR = 0.22; p = 0.074). No relevant associations were found for having tattoos (recent or old), regular sports practice or sharing clothes. Regarding age groups, although statistical significance was not reached at the 5% level, a trend towards increased risk was observed in the age group over 50 years (OR = 3.39; 95% CI: 1.02–11.30; p = 0.072). The variables of ethnicity, education level, and marital status did not show statistically significant differences between the groups (p > 0.05). Concerning clinical history, including HIV status, hospitalizations in the last 12 months, or recent antibiotic use, no statistically significant differences were observed between positive and negative cases in this sample. DISCUSSION This study sought to understand how certain self-care practices and dynamics might be related to CA-MRSA colonization among MSM in the central region of Rio Grande do Sul, Brazil, comparing the local findings with studies conducted in other countries. The results of this study identify sexual orientation as a statistically significant predictor for CA-MRSA/MRCoNS colonization, establishing a relevant epidemiological dichotomy: a significantly increased risk was observed in the heterosexual group (OR: 5.12; p = 0.021) and in contrast to a protective trend among MSM (OR: 0.20; p = 0.021) and showering after sex as significant protective factors (OR: 0.16) (Fig. 2, Table S01). These findings contrast substantially with the global landscape described in the recent systematic review by, De Jong et al. ( 2025 ). In their comprehensive analysis of MRSA prevalence among MSM, the authors identified this group as a high-risk population for the acquisition and transmission of methicillin-resistant S. aureus strains (such as the USA300 clone), often associated with dense sexual networks and high-risk behaviors. However, in our study, the MSM group presented a significantly lower probability of colonization (OR = 0.20) compared to heterosexual participants. This divergence from the data reported by De Jong et al. ( 2025 ) may be explained by specific behavioral factors within our sample. The variable "showering after sexual intercourse" proved to be highly protective in our model and may be more prevalent or performed more rigorously in the MSM subgroup studied, potentially mitigating the risk of skin-to-skin transmission frequently reported in the literature. While De Jong et al. ( 2025 ) emphasize transmission within sexual networks as a driver for outbreaks in MSM, our data suggest that, in certain local contexts, personal hygiene habits may override sexual orientation as determinants of colonization. The elevated risk observed among heterosexuals—an atypical finding in Community-Acquired MRSA (CA-MRSA) studies—warns against neglecting this group in screening strategies, as the perception of "low risk" may lead to less rigorous hygiene practices or delayed diagnosis. Finally, it is important to note that although advanced age (> 50 years) showed a trend towards increased risk in our study, De Jong et al. ( 2025 ) focus predominantly on younger sexually active populations. The differences in age profile should be considered when interpreting these discrepancies, as our study included a higher proportion of individuals aged over 50 years compared to the predominantly younger populations analyzed in the systematic review. Witzel and colleagues (2014) identified being MSM as a significant risk factor for S. aureus colonization (overall), in a prison confinement environment where MRSA prevalence was extremely low (0.7%). In direct contrast, our analysis revealed that, in the population studied, being MSM behaved as a protective factor (OR = 0.20), while heterosexual orientation emerged as an independent risk predictor (OR = 5.12). This discrepancy can be attributed to fundamental differences in the environmental and behavioral contexts of the two samples. In the prison study by Witzel et al., transmission is facilitated by overcrowding and precarious hygienic conditions, where risk behaviors (such as sharing objects or close physical contact in cells) may exacerbate colonization in MSM. On the other hand, our sample, by demonstrating a strong protective association with post-coital hygiene ("showering after sex", OR = 0.16), suggests that the MSM group in our study may have higher adherence to personal hygiene practices that effectively mitigate the risk of cutaneous colonization, a factor that may be compromised in the prison scenario described by Witzel. Additionally, while Witzel and colleagues (2014) focused on nasopharyngeal carriage and found a residual MRSA rate, our study (which considers MRSA/MRCoNS) found robust behavioral associations. This reinforces the idea that, outside of strict confinement environments, individual behavioral variables (such as specific hygiene after sexual intercourse) may carry greater weight than sexual orientation per se or simple overcrowding in determining carrier status. Sztramko et al. ( 2007 ) documented a cluster of CA-MRSA infections (USA300 clone) predominantly in MSM, suggesting that this group constitutes a high-risk reservoir for community transmission of this pathogen, driven by dense sexual networks and frequent skin-to-skin contact. Furthermore, the relationship with HIV infection presented distinct dynamics. In Sztramko's series, 71% of MRSA cases occurred in HIV-positive individuals, suggesting a strong epidemiological overlap and possible biological susceptibility. In our study, although HIV prevalence was high in the overall sample, serological status per se did not significantly discriminate between colonized and non-colonized individuals ( p = 0.576) (Table S01). This indicates that, in our local context, colonization by resistant S. aureus seems to be governed more by universal behavioral factors (such as hygiene) than by immune status or sexual orientation alone. The results of the present study align with the observations of Giuliani et al. ( 2010 ) in Italy, challenging the widespread notion that the population of MSM universally constitutes a high-risk reservoir for CA-MRSA. In their cross-sectional study involving 104 HIV-infected MSM in Rome, Giuliani and colleagues detected no cases of MRSA colonization, contrasting with the high circulation of the USA300 clone described in the United States. Concordantly, our data revealed that being MSM constituted a significant protective factor (OR = 0.20) compared to the heterosexual population, which presented a substantially higher risk (OR = 5.12) (Table S01). While Giuliani et al. ( 2010 ) attributed the absence of MRSA to local epidemiological differences (lack of circulation of epidemic clones), our study suggests that behavioral factors may be determinant. Both studies reinforce the need not to stigmatize sexual orientation as a risk factor per se , pointing to the importance of geographical context and individual hygiene practices. Despite the global trend associating MSM sexual networks with the dissemination of specific MRSA clones, genomic analysis has been used to reinforce this connection in other contexts. Popovich et al. ( 2021 ) highlight the application of genomic sequencing to delineate the transmission networks of MRSA among MSM, often associating the USA300 clone with this population group. Studies referenced by Popovich (2021) suggest that person-to-person contact, facilitated by sexual activity, drives MRSA transmission at anatomical sites such as the buttocks, genitals, and perineum. These results should be viewed alongside the broader epidemiological context of MSM in Brazil. While we found a 6.8% CA-MRSA prevalence, other pathogens show substantially higher rates. Kerr et al. ( 2018 ) reported an HIV prevalence of 18.4% in a national multicenter respondent-driven sampling survey among MSM, while Jalil et al. (2023) found a prevalence of 9.8% among young MSM in Rio de Janeiro. Syphilis also remains a significant burden in Brazilian MSM populations, with several studies reporting elevated prevalence levels across major urban centers. These patterns have been frequently associated with structural stigma and barriers to healthcare access. CONCLUSIONS This study challenges the prevailing paradigm that MSM are inherently a high-risk group for CA-MRSA colonization. In our Brazilian cohort, MSM exhibited a significant protective association, whereas heterosexual men emerged as the primary risk group. This pattern may be influenced by behavioral factors, notably the protective effect of post-coital showering, indicating that hygiene practices may modulate risks commonly associated with sexual networks. These findings highlight the need to shift public health focus from stigmatizing sexual orientations to promoting universal hygiene measures, ensuring that heterosexual populations are not overlooked in MRSA surveillance and prevention strategies. The discrepancy between the local panorama (Santa Maria, Brazil) and the global scenario may reflect a divergent epidemiology dynamics regarding dominant clones, such as USA300, or, more notably, suggests that individual hygiene practices, may be a more powerful behavioral factor in mitigating the risk of colonization than sexual orientation, effectively breaking the transmission chains documented by genomic sequencing studies in other regions. Declarations Competing Interests The authors have no relevant financial or non-financial interests to disclose. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Universidade Franciscana (N. 7.265.473). Consent to participate Informed consent was obtained from all individual participants included in the study. Funding This work was supported by FAPERGS (Foundation for the Supporting of Research in the State of Rio Grande do Sul) under Grant Number 23/2551-0000776-2. Author Contribution **B.C.F:** data curation, investigation, methodology and writing—original draft; **M.R.B:** Investigation, Methodology; **E.O.P:** Investigation, Methodology; **C.T.M** : software; **D.B.S** : Investigation, Methodology; **F.M.G:** supervision; **B.S.V:** project administration, supervision, Writing—Review and editing; Data Availability The datasets generated during and/or analyzed during the current study are not publicly available due to the sensitive nature of the data but are available from the corresponding author on reasonable request References AMERICAN PSYCHIATRIC ASSOCIATION (1987) Diagnostic and Statistical Manual of Mental Disorders , 3rd ed., revised. 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Wayne, PA: Clinical and Laboratory Standards Institute DE JONG GM et al (2025) Methicillin-resistant Staphylococcus aureus (MRSA) in men having sex with men (MSM): a systematic review. BMC Infect Dis 25(1):299. 10.1186/s12879-025-10593-3 DIEP BA et al (2008) Difficult-to-Treat Staphylococcal Infections in Men Who Have Sex with Men. Ann Intern Med 148(4):I–42. https://doi.org/10.7326/0003-4819-148-4-200802190-00203 GALINDO GR et al (2012) Community associated methicillin resistant Staphylococcus aureus among New York City men who have sex with men: Qualitative research findings and implications for public health practice. J Community Health 37:2, 458–467 GERYMSKI R, MAGOŃ W (2023) Chemsex and Sexual Well-Being in Young Polish Men. Int J Environ Res Public Health 20:12 GIULIANI M et al (2010) No evidence of colonization with community-acquired methicillin-resistant Staphylococcus aureus in HIV-1-infected men who have sex with men. 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J Infect Dis 223(4):543–546 SZTRAMKO R et al (2007) Community-associated methicillin-resistant Staphylococcus aureus infections in men who have sex with men: a case series. Can J Infect Dis Med Microbiol 18:4, 257–261 SZUMOWSKI JD et al (2009) Methicillin-resistant Staphylococcus aureus colonization, behavioral risk factors, and skin and soft-tissue infection at an ambulatory clinic serving a large population of HIV-infected men who have sex with men. Clin Infect Dis THOMAS LC et al (2007) Development of a real-time Staphylococcus aureus and MRSA (SAM-) PCR for routine blood culture. J. Microbiol. Method s 68, 2, 296–302 WITZEL CL et al (2014) Nasopharyngeal carriage of Staphylococcus aureus among imprisoned males from Brazil without exposure to healthcare: risk factors and molecular characterization. Ann Clin Microbiol Antimicrob 13:25 WORLD HEALTH ORGANIZATION (2024) Bacterial Priority Pathogens List 2024 Bacterial pathogens of public health importance to guide research development and strategies to prevent and control antimicrobial resistance Tables Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files floatimage3.png Table 1. Antimicrobial profile for the MRSA strains obtained from MSM and heterosexual groups. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8492252","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":570071337,"identity":"38f1f0f8-0349-46c2-806e-b5125f0cd2a3","order_by":0,"name":"Bruno de Christo Felicidade","email":"","orcid":"","institution":"Universidade Franciscana – UFN, Santa Maria-RS","correspondingAuthor":false,"prefix":"","firstName":"Bruno","middleName":"de Christo","lastName":"Felicidade","suffix":""},{"id":570071339,"identity":"ecea2cce-7bd9-4e98-b882-300894e6cf75","order_by":1,"name":"Mayara Rodrigues Bicca","email":"","orcid":"","institution":"Universidade Franciscana – UFN, Santa Maria-RS","correspondingAuthor":false,"prefix":"","firstName":"Mayara","middleName":"Rodrigues","lastName":"Bicca","suffix":""},{"id":570071342,"identity":"bec87134-a844-4424-9818-c38f99fe7b3b","order_by":2,"name":"Eduarda Oliveira Pinto","email":"","orcid":"","institution":"Universidade Franciscana – UFN, Santa Maria-RS","correspondingAuthor":false,"prefix":"","firstName":"Eduarda","middleName":"Oliveira","lastName":"Pinto","suffix":""},{"id":570071344,"identity":"df3b280a-c808-43d9-a684-d3010c9a623f","order_by":3,"name":"Félix Miguel Nascimento Guazina","email":"","orcid":"","institution":"Universidade Franciscana – UFN, Santa Maria-RS","correspondingAuthor":false,"prefix":"","firstName":"Félix","middleName":"Miguel Nascimento","lastName":"Guazina","suffix":""},{"id":570071345,"identity":"fda63fd8-8c43-4905-a0e5-46c77e72b522","order_by":4,"name":"Clandio Timm 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13:36:51","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":96606,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8492252/v1/edb7207ebf3d6a916b81814f.html"},{"id":99668131,"identity":"99bef232-fca6-4ab9-bab9-f80c19d23369","added_by":"auto","created_at":"2026-01-07 06:16:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":384046,"visible":true,"origin":"","legend":"\u003cp\u003eqPCR detection of \u003cem\u003emecA\u003c/em\u003e and \u003cem\u003enuc\u003c/em\u003e genes for the CA-MRSA strains analyzed in the study.\u003c/p\u003e","description":"","filename":"floatimage145.png","url":"https://assets-eu.researchsquare.com/files/rs-8492252/v1/8c6f582a174a90260f47f8d1.png"},{"id":100546212,"identity":"012cf762-4ded-4512-baa7-b5588219cbf7","added_by":"auto","created_at":"2026-01-19 08:01:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1294860,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8492252/v1/0546a55d-d228-4e96-a39f-a3c01b9da6f6.pdf"},{"id":99794971,"identity":"32d6a0df-5a58-43ed-9a9d-ab18a1ca55f3","added_by":"auto","created_at":"2026-01-08 13:36:45","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":78883,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Antimicrobial profile for the MRSA strains obtained from MSM and heterosexual groups.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8492252/v1/252a21e6050c4fcac4e97af2.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMen Who Have Sex With Men: Sexual Behavior May Not Represent an Increased Risk for Methicillin-Resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e Colonization\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMethicillin-resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MRSA) is a high-priority pathogen due to its high prevalence, especially in first-world countries such as the USA and Europe, where the pathogen is one of the most prevalent, representing a significant global risk. According to Lemon (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), at least 10,000 individuals died in the USA from MRSA infections. Among its main risk elements is the USA300 clone, a particularly virulent and resistant strain of MRSA, which has spread widely in the community, increasing the risk of this pathogen (Augusto et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). With the significant growth in MRSA infections, it has become increasingly common to find healthy individuals colonized by the bacteria, even without a recent history of hospitalization or contact with healthcare institutions. Although such individuals have no risk factors previously linked to infection, this has highlighted the spread of MRSA beyond the hospital setting. This growth has presented an extra challenge, as community-associated MRSA (CA-MRSA) has shown a reduced response to commonly used antibiotics, increasing its incidence in various population groups (Galindo et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong the different population groups affected by CA-MRSA, the LGBTQIAPN+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Pansexual) community stands out, a community that has historically been associated with concepts such as sexually transmitted infections (STIs) and chemsex. It should be noted that homosexuality was only removed from the Diagnostic and Statistical Manual of Disorders (DSM-III-R) in 1990, while transsexuality was only declassified as a mental disorder in 2018, when the DSM-5 was updated (American Psychiatric Association, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1987\u003c/span\u003e; \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs CA-MRSA has become known, it is more frequent in different social groups, including cisgender men who are homosexual, bisexual, and/or men who have sex with other men (MSM), who face daily inequalities in relation to sexual health compared to heterosexual cisgender individuals (Gerymski and Magoń, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The impact of CA-MRSA on these individuals not only poses a risk to their physical but also to their mental health, involving not only bacterial colonization but also the discrimination and stigma that these individuals face daily, which can significantly increase the prevalence of mental disorders, such as anxiety and depression, among others (WHO, 2017).\u003c/p\u003e \u003cp\u003eThe need for integrated care that considers the physical and mental health of the LGBTQIAPN\u0026thinsp;+\u0026thinsp;community is reinforced by the correlation between risk factors, such as illicit drug use, anonymous sex and contact with people who have skin infections can be considered risk actions for MSM (Szumowski et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Issues such as skin and soft tissue infections and abscesses are recurrent among those infected with CA-MRSA. Also, although less recurrent, CA-MRSA can lead to more serious infections, such as pneumonia, endocarditis, and osteomyelitis. In addition, the possible link between CA-MRSA and MSM can negatively affect the mental health and quality of life of these individuals, especially in a community that has suffered and still suffers from many prejudices (Lee et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Although the specific connection that exists between MRSA and the cisgender gay, bisexual, and/or MSM community is still unexplored.\u003c/p\u003e \u003cp\u003eSeeking to develop and promote culturally competent prevention and care strategies adapted to the specific needs of the MSM population, presenting methods to prevent and treat infectious diseases that affect this community, and providing this population with culturally appropriate health care, we aimed to collect epidemiological data on CA-MRSA nasal colonization in MSM individuals living in the municipality of Santa Maria, RS, Brazil, also in a way to verify if there is a link between sexual behavior and colonization/infection by this pathogen.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthics\u003c/h2\u003e \u003cp\u003eThe present study is cross-sectional, with a quantitative and analytical nature, conducted to determine the prevalence of CA-MRSA/MRCoNS colonization and identify the association of demographic and behavioral risk factors in the study population through data collection performed at a single point in time. The study was approved by the Universidade Franciscana Research Ethics Committee (N. 7.265.473). All participants were over 18 years old and signed a free and informed consent form (FICF) before taking part in the research, in accordance with the ethical guidelines for studies with human beings.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling\u003c/h3\u003e\n\u003cp\u003eA convenience sampling approach was employed, involving men assisted at the Specialized Assistance Service (SAE) and the Testing and Counselling Centre (CTA) in Santa Maria, Rio Grande do Sul, Brazil. From an estimated reference population of 975 to 1,050 individuals attended during this period, a sample of 100 participants was recruited, yielding a 9.3% margin of error with a 95% confidence level. The study was conducted between May and August 2025 and involved two stages of collection: (1) a self-administered questionnaire containing sociodemographic data (age, educational level, marital status, and sexual orientation), clinical data (comorbidities, history of infections, hospitalization, antibiotic use, and HIV status), and behavioral data (sexual practices, hygiene habits, substance use, physical activity, and social exposure) and (2) nasal swab collection. All data were treated confidentially and anonymously. The inclusion criteria were: (1) male individuals aged 18 years or older; (2) those who sought care or assistance at the SAE or CTA in Santa Maria during the study period; and (3) individuals who self-identified as men who have sex with men (MSM) or cisgender heterosexual men. The exclusion criteria were: (1) recent antibiotic use; (2) presence of chronic diseases; and (3) individuals who did not identify with either of the sexual orientation categories considered in the study. Individuals who did not provide information on sexual orientation (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;9) or who did not meet the group categorization criteria (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;2) were excluded from the final analysis, and no methods for imputing missing data were applied.\u003c/p\u003e\n\u003ch3\u003eMicrobiological characterization\u003c/h3\u003e\n\u003cp\u003eNasal samples were collected in Stuart swabs (Laborclin\u003csup\u003e\u0026reg;\u003c/sup\u003e) from the study participants and immediately transported at room temperature to the Molecular Microbiology Research Laboratory (LaPeMM) for processing. Swabs were inoculated in Brain Heart Infusion (BHI, Himedia\u0026reg;) broth and incubated at 37\u0026deg;C for a period of 18 to 24 hours. After enrichment, aliquots of each culture were sown on Blood Agar and Mannitol Salt Agar (Himedia\u0026reg;) supplemented with oxacillin (4 \u0026micro;g/mL). After incubation, colonial morphology was assessed by Gram staining and confirmation by biochemical tests (Laborclin\u003csup\u003e\u0026reg;\u003c/sup\u003e). The confirmed isolates of \u003cem\u003eS. aureus\u003c/em\u003e were submitted to the evaluation of the antimicrobial susceptibility profile by Kirby-Bauer (1966) disk-diffusion method, using Mueller-Hinton Agar and following the BrCAST 2025 guidelines, for levofloxacin, gentamicin, amikacin, erythromycin, cefoxitin, sulfamethoxazole-trimethoprim, penicillin, linezolid, rifampicin, and tetracycline. Isolates presenting resistance to cefoxitin were classified as methicillin-resistant and considered presumptive of MRSA (CLSI, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eMolecular characterization\u003c/h3\u003e\n\u003cp\u003eGenomic DNA was extracted from MRSA isolates using a commercial kit (manufacturer) following the manufacturer's protocol. PCR reactions were carried out to detect the \u003cem\u003emecA\u003c/em\u003e gene, responsible for methicillin resistance, with the primers \u003cem\u003emecA-F\u003c/em\u003e (5'- AAA GAA CCT CTG CTC AAC AAG T-3'), \u003cem\u003emecA-R\u003c/em\u003e (5'- TGT TAT TTA ACC CAA TCA TTG CTG TT-3'), \u003cem\u003enuc-F\u003c/em\u003e GAA TGT CAT TGG TTG ACC TTT GTA and \u003cem\u003enuc-\u003c/em\u003eR AAA TTA CAT AAA GAA CCT GCG ACA (Thomas et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). The amplification was carried out at QuantStudio\u0026trade; 5 Real-Time PCR (Thermo Fisher Scientific) using SYBR\u0026trade; Green qPCR Master Mix (Thermo Fisher Scientific) in a 10 \u0026micro;L reaction volume.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eQuantitative data were analyzed using SPSS software (version 25.0) for all statistical calculations. Continuous variables were categorized according to predefined questionnaire categories or epidemiologically relevant cut-off points. The Gemini artificial intelligence tool was used exclusively for data organization and formatting to facilitate readability and was not involved in statistical testing. \u003cem\u003eP\u003c/em\u003e-values were calculated using Fisher\u0026rsquo;s Exact Test (two-sided); Odds Ratios (OR) and their 95% Confidence Intervals (CI) were determined, with a significance level set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Multivariate analysis was not performed due to the limited number of positive outcomes (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;15). Given the exploratory nature of the study and the sample size, univariate analysis using Fisher\u0026rsquo;s Exact Test and Odds Ratios was considered the most appropriate approach to minimize overfitting. This study was reported in accordance with the STROBE guidelines for observational studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe study analyzed 44 MSM (9 bisexual and 35 homosexual) and 45 cisgender heterosexual men's nasal samples. A total of 11 individuals were not analyzed by the study, where 9 preferred not to answer about their sexual orientation, 1 had another sexual orientation that was not covered in the questionnaire, and 1 was transsexual. For the MSM group, 6 strains of \u003cem\u003eS. aureus\u003c/em\u003e showed resistance to FOX, with 3 strains (6.8%) confirmed as CA-MRSA by qPCR analysis. For the heterosexual group, we isolated 13 strains of \u003cem\u003eS. aureus\u003c/em\u003e resistant to FOX, with 9 strains (20%) confirmed as CA-MRSA. Another 3 strains (6.6%) of coagulase-negative \u003cem\u003eStaphylococci\u003c/em\u003e (CoNS) isolated in the heterosexual group showed resistance to FOX (MRCoNS) and were confirmed to be carrying the \u003cem\u003emecA\u003c/em\u003e gene (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e`Antimicrobial susceptibility testing performed on \u003cem\u003eS. aureus\u003c/em\u003e isolates revealed varied resistance profiles among the samples (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The results show a predominance of resistance to FOX and RIF across the \u003cem\u003eS. aureus\u003c/em\u003e and CoNS isolates, with several isolates displaying variable susceptibility to other agents such as CLI, GEN, and TET. The presence of \u003cem\u003emecA\u003c/em\u003e gene was confirmed in all tested samples, indicating a potential for methicillin resistance. Variations in susceptibility were also identified for other classes of antimicrobials, such as fluoroquinolones, macrolides, aminoglycosides, and rifamycins, indicating the presence of genetically diverse isolates among the analyzed samples, according to BrCAST (2025) guidelines. These findings demonstrate the epidemiological relevance of resistant strains of \u003cem\u003eS. aureus\u003c/em\u003e spread in community settings and suggest potential challenges for the control and treatment of such infections.\u003c/p\u003e \u003cp\u003eTable 1. Antimicrobial profile for the MRSA strains obtained from MSM and heterosexual groups.\u003c/p\u003e \u003cp\u003e After microbiological characterization and antimicrobial susceptibility profiling, possible behavioral and demographic factors associated with nasal colonization by MRSA/MRCoNS were analyzed using a questionnaire aimed at identifying potential predictors of its colonization among the participants. Although most variables did not show statistically significant associations, some factors demonstrated relevant trends (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of sociodemographic and behavioral factors between mrsa/mrcons positive and negative groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable / Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMRSA/MRCoNS Positive (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMRSA/MRCoNS Negative (n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSEXUAL ORIENTATION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeterosexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.12 (1.33\u0026ndash;19.71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSM (Homosexual/Bisexual)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (56.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.20 (0.05\u0026ndash;0.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eETHNICITY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (65.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.43 (0.41\u0026ndash;4.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack / Mixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (32.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.51 (0.13\u0026ndash;1.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAGE GROUP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;30 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.90 (0.26\u0026ndash;3.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;40 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.41 (0.08\u0026ndash;1.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;50 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.66 (0.17\u0026ndash;2.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.39 (1.02\u0026ndash;11.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEDUCATION LEVEL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (38.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.41 (0.77\u0026ndash;7.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.26 (0.05\u0026ndash;1.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMARITAL STATUS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (74.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.70 (0.21\u0026ndash;2.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.97 (0.24\u0026ndash;3.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCLINICAL HISTORY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58 (79.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.03 (0.26\u0026ndash;4.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization (last 12m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (17.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.31 (0.67\u0026ndash;7.89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotic Use (last 3m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (45.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.61 (0.19\u0026ndash;1.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHABITS \u0026amp; HYGIENE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShowering after sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69 (94.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.16 (0.03\u0026ndash;0.73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTattoos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (69.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.65 (0.21\u0026ndash;2.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecent Tattoo (last 6m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.09 (0.37\u0026ndash;11.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular Sports Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (47.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.72 (0.23\u0026ndash;2.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSharing Clothes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.97 (0.11\u0026ndash;8.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRISK BEHAVIORS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnprotected Sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.22 (0.05\u0026ndash;1.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex Club / Swing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (5.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.23 (0.13\u0026ndash;11.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreated for STI (non-HIV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.55 (0.11\u0026ndash;2.68)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHIV STATUS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV Positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (57.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.48 (0.46\u0026ndash;4.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSEXUAL BEHAVIOR\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(LAST 3 MONTHS)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual partners (1 to 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (68.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.69 (0.22\u0026ndash;2.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual partners (3 to 4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;7.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual partners (\u0026gt;\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.80 (0.09\u0026ndash;7.16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnprotected sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.38 (0.10\u0026ndash;1.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.40 (0.05\u0026ndash;3.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;13.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eITEMS SHARED WITH PARTNER\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTowels (with partner)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.68 (0.21\u0026ndash;2.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal hygiene products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.62 (0.18\u0026ndash;2.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex toys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (11.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.25 (0.24\u0026ndash;6.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRazors / Shaving equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (11.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;4.54)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClothing / Personal garments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (5.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;9.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHABITS \u0026amp; LIFESTYLE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIllicit substance use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.05 (0.26\u0026ndash;4.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNail biting (Onychophagia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.62 (0.18\u0026ndash;2.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular sports practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.90 (0.29\u0026ndash;2.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTravel abroad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (13.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;3.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHabit of reading/researching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (46.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (58.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.61 (0.20\u0026ndash;1.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLIVING SITUATION\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLives with sexual partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.72 (0.22\u0026ndash;2.31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLives with other(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.53 (0.42\u0026ndash;5.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLives alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96 (0.31\u0026ndash;2.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSHARED EQUIPMENT \u0026amp; ENVIRONMENTS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGym equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.66 (0.17\u0026ndash;2.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttended gym\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.44 (0.09\u0026ndash;2.12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShared towels (General)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.67 (0.08\u0026ndash;5.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSauna and showers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.54 (0.21\u0026ndash;29.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJoined sports team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.97 (0.11\u0026ndash;8.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShared clothes/uniforms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (5.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.23 (0.13\u0026ndash;11.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCLINICAL \u0026amp; PSYCHOSOCIAL HISTORY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological/Psychiatric counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.66 (0.17\u0026ndash;2.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas support network\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.55 (0.16\u0026ndash;1.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecent imprisonment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.97 (0.11\u0026ndash;8.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization (last 12m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.51 (0.06\u0026ndash;4.34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreated for skin infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.97 (0.11\u0026ndash;8.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePart of social movement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;3.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe comparative analysis between participants with CA-MRSA/MRCoNS colonization (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;15) and the negative control group (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;73) revealed statistically significant associations regarding variables related to sexual orientation and hygiene habits. Concerning sociodemographic characteristics, sexual orientation proved to be a relevant discriminating factor. Identifying as heterosexual presented as a significant risk factor for colonization, with a likelihood of occurrence more than five times higher compared to other groups (OR\u0026thinsp;=\u0026thinsp;5.12; 95% CI: 1.33\u0026ndash;19.71; ). Conversely, the group of Men who have Sex with Men (MSM) revealed an inverse association, suggesting a protective effect or lower prevalence in this specific sample (OR\u0026thinsp;=\u0026thinsp;0.20; 95% CI: 0.05\u0026ndash;0.75; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.021).\u003c/p\u003e \u003cp\u003eRegarding hygiene habits and lifestyle, showering after sexual intercourse stood out as a statistically significant variable, associated with a marked reduction in the probability of positive colonization (OR\u0026thinsp;=\u0026thinsp;0.16; 95% CI: 0.03\u0026ndash;0.73; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.026). Other behaviors, such as unprotected sex, showed a trend towards a negative association, although not significant (OR\u0026thinsp;=\u0026thinsp;0.22; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.074). No relevant associations were found for having tattoos (recent or old), regular sports practice or sharing clothes.\u003c/p\u003e \u003cp\u003eRegarding age groups, although statistical significance was not reached at the 5% level, a trend towards increased risk was observed in the age group over 50 years (OR\u0026thinsp;=\u0026thinsp;3.39; 95% CI: 1.02\u0026ndash;11.30; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.072). The variables of ethnicity, education level, and marital status did not show statistically significant differences between the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Concerning clinical history, including HIV status, hospitalizations in the last 12 months, or recent antibiotic use, no statistically significant differences were observed between positive and negative cases in this sample.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study sought to understand how certain self-care practices and dynamics might be related to CA-MRSA colonization among MSM in the central region of Rio Grande do Sul, Brazil, comparing the local findings with studies conducted in other countries.\u003c/p\u003e \u003cp\u003eThe results of this study identify sexual orientation as a statistically significant predictor for CA-MRSA/MRCoNS colonization, establishing a relevant epidemiological dichotomy: a significantly increased risk was observed in the heterosexual group (OR: 5.12; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.021) and in contrast to a protective trend among MSM (OR: 0.20; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.021) and showering after sex as significant protective factors (OR: 0.16) (Fig.\u0026nbsp;2, Table S01). These findings contrast substantially with the global landscape described in the recent systematic review by, De Jong et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In their comprehensive analysis of MRSA prevalence among MSM, the authors identified this group as a high-risk population for the acquisition and transmission of methicillin-resistant \u003cem\u003eS. aureus\u003c/em\u003e strains (such as the USA300 clone), often associated with dense sexual networks and high-risk behaviors. However, in our study, the MSM group presented a significantly lower probability of colonization (OR\u0026thinsp;=\u0026thinsp;0.20) compared to heterosexual participants. This divergence from the data reported by De Jong et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) may be explained by specific behavioral factors within our sample. The variable \"showering after sexual intercourse\" proved to be highly protective in our model and may be more prevalent or performed more rigorously in the MSM subgroup studied, potentially mitigating the risk of skin-to-skin transmission frequently reported in the literature.\u003c/p\u003e \u003cp\u003eWhile De Jong et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) emphasize transmission within sexual networks as a driver for outbreaks in MSM, our data suggest that, in certain local contexts, personal hygiene habits may override sexual orientation as determinants of colonization. The elevated risk observed among heterosexuals\u0026mdash;an atypical finding in Community-Acquired MRSA (CA-MRSA) studies\u0026mdash;warns against neglecting this group in screening strategies, as the perception of \"low risk\" may lead to less rigorous hygiene practices or delayed diagnosis. Finally, it is important to note that although advanced age (\u0026gt;\u0026thinsp;50 years) showed a trend towards increased risk in our study, De Jong et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) focus predominantly on younger sexually active populations. The differences in age profile should be considered when interpreting these discrepancies, as our study included a higher proportion of individuals aged over 50 years compared to the predominantly younger populations analyzed in the systematic review.\u003c/p\u003e \u003cp\u003eWitzel and colleagues (2014) identified being MSM as a significant risk factor for \u003cem\u003eS. aureus\u003c/em\u003e colonization (overall), in a prison confinement environment where MRSA prevalence was extremely low (0.7%). In direct contrast, our analysis revealed that, in the population studied, being MSM behaved as a protective factor (OR\u0026thinsp;=\u0026thinsp;0.20), while heterosexual orientation emerged as an independent risk predictor (OR\u0026thinsp;=\u0026thinsp;5.12). This discrepancy can be attributed to fundamental differences in the environmental and behavioral contexts of the two samples. In the prison study by Witzel et al., transmission is facilitated by overcrowding and precarious hygienic conditions, where risk behaviors (such as sharing objects or close physical contact in cells) may exacerbate colonization in MSM. On the other hand, our sample, by demonstrating a strong protective association with post-coital hygiene (\"showering after sex\", OR\u0026thinsp;=\u0026thinsp;0.16), suggests that the MSM group in our study may have higher adherence to personal hygiene practices that effectively mitigate the risk of cutaneous colonization, a factor that may be compromised in the prison scenario described by Witzel. Additionally, while Witzel and colleagues (2014) focused on nasopharyngeal carriage and found a residual MRSA rate, our study (which considers MRSA/MRCoNS) found robust behavioral associations. This reinforces the idea that, outside of strict confinement environments, individual behavioral variables (such as specific hygiene after sexual intercourse) may carry greater weight than sexual orientation \u003cem\u003eper se\u003c/em\u003e or simple overcrowding in determining carrier status.\u003c/p\u003e \u003cp\u003eSztramko et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) documented a cluster of CA-MRSA infections (USA300 clone) predominantly in MSM, suggesting that this group constitutes a high-risk reservoir for community transmission of this pathogen, driven by dense sexual networks and frequent skin-to-skin contact. Furthermore, the relationship with HIV infection presented distinct dynamics. In Sztramko's series, 71% of MRSA cases occurred in HIV-positive individuals, suggesting a strong epidemiological overlap and possible biological susceptibility. In our study, although HIV prevalence was high in the overall sample, serological status \u003cem\u003eper se\u003c/em\u003e did not significantly discriminate between colonized and non-colonized individuals (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.576) (Table S01). This indicates that, in our local context, colonization by resistant \u003cem\u003eS. aureus\u003c/em\u003e seems to be governed more by universal behavioral factors (such as hygiene) than by immune status or sexual orientation alone.\u003c/p\u003e \u003cp\u003eThe results of the present study align with the observations of Giuliani et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) in Italy, challenging the widespread notion that the population of MSM universally constitutes a high-risk reservoir for CA-MRSA. In their cross-sectional study involving 104 HIV-infected MSM in Rome, Giuliani and colleagues detected no cases of MRSA colonization, contrasting with the high circulation of the USA300 clone described in the United States. Concordantly, our data revealed that being MSM constituted a significant protective factor (OR\u0026thinsp;=\u0026thinsp;0.20) compared to the heterosexual population, which presented a substantially higher risk (OR\u0026thinsp;=\u0026thinsp;5.12) (Table S01). While Giuliani et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) attributed the absence of MRSA to local epidemiological differences (lack of circulation of epidemic clones), our study suggests that behavioral factors may be determinant. Both studies reinforce the need not to stigmatize sexual orientation as a risk factor \u003cem\u003eper se\u003c/em\u003e, pointing to the importance of geographical context and individual hygiene practices.\u003c/p\u003e \u003cp\u003eDespite the global trend associating MSM sexual networks with the dissemination of specific MRSA clones, genomic analysis has been used to reinforce this connection in other contexts. Popovich et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) highlight the application of genomic sequencing to delineate the transmission networks of MRSA among MSM, often associating the USA300 clone with this population group. Studies referenced by Popovich (2021) suggest that person-to-person contact, facilitated by sexual activity, drives MRSA transmission at anatomical sites such as the buttocks, genitals, and perineum. These results should be viewed alongside the broader epidemiological context of MSM in Brazil. While we found a 6.8% CA-MRSA prevalence, other pathogens show substantially higher rates. Kerr et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) reported an HIV prevalence of 18.4% in a national multicenter respondent-driven sampling survey among MSM, while Jalil et al. (2023) found a prevalence of 9.8% among young MSM in Rio de Janeiro. Syphilis also remains a significant burden in Brazilian MSM populations, with several studies reporting elevated prevalence levels across major urban centers. These patterns have been frequently associated with structural stigma and barriers to healthcare access.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study challenges the prevailing paradigm that MSM are inherently a high-risk group for CA-MRSA colonization. In our Brazilian cohort, MSM exhibited a significant protective association, whereas heterosexual men emerged as the primary risk group. This pattern may be influenced by behavioral factors, notably the protective effect of post-coital showering, indicating that hygiene practices may modulate risks commonly associated with sexual networks.\u003c/p\u003e \u003cp\u003eThese findings highlight the need to shift public health focus from stigmatizing sexual orientations to promoting universal hygiene measures, ensuring that heterosexual populations are not overlooked in MRSA surveillance and prevention strategies. The discrepancy between the local panorama (Santa Maria, Brazil) and the global scenario may reflect a divergent epidemiology dynamics regarding dominant clones, such as USA300, or, more notably, suggests that individual hygiene practices, may be a more powerful behavioral factor in mitigating the risk of colonization than sexual orientation, effectively breaking the transmission chains documented by genomic sequencing studies in other regions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003e \u003cem\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/em\u003e \u003c/p\u003e\u003ch2\u003eEthics approval\u003c/h2\u003e \u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Universidade Franciscana (N. 7.265.473).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by FAPERGS (Foundation for the Supporting of Research in the State of Rio Grande do Sul) under Grant Number 23/2551-0000776-2.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e**B.C.F:** data curation, investigation, methodology and writing\u0026mdash;original draft; **M.R.B:** Investigation, Methodology; **E.O.P:** Investigation, Methodology; **C.T.M** : software; **D.B.S** : Investigation, Methodology; **F.M.G:** supervision; **B.S.V:** project administration, supervision, Writing\u0026mdash;Review and editing;\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during and/or\u0026nbsp;analyzed\u0026nbsp;during the current study are not publicly available due to\u0026nbsp;the sensitive nature of the data\u0026nbsp;but are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAMERICAN PSYCHIATRIC ASSOCIATION (1987) \u003cem\u003eDiagnostic and Statistical Manual of Mental Disorders\u003c/em\u003e, 3rd ed., revised. 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Can J Infect Dis Med Microbiol 18:4, 257\u0026ndash;261\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSZUMOWSKI JD et al (2009) Methicillin-resistant Staphylococcus aureus colonization, behavioral risk factors, and skin and soft-tissue infection at an ambulatory clinic serving a large population of HIV-infected men who have sex with men. Clin Infect Dis\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTHOMAS LC et al (2007) Development of a real-time Staphylococcus aureus and MRSA (SAM-) PCR for routine blood culture. \u003cem\u003eJ. Microbiol. Method\u003c/em\u003es 68, 2, 296\u0026ndash;302\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWITZEL CL et al (2014) Nasopharyngeal carriage of Staphylococcus aureus among imprisoned males from Brazil without exposure to healthcare: risk factors and molecular characterization. Ann Clin Microbiol Antimicrob 13:25\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWORLD HEALTH ORGANIZATION (2024) Bacterial Priority Pathogens List 2024 Bacterial pathogens of public health importance to guide research development and strategies to prevent and control antimicrobial resistance\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Microbiota, Multidrug resistance, Public Health, CA-MRSA, homossexuality","lastPublishedDoi":"10.21203/rs.3.rs-8492252/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8492252/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eColonization by community-associated methicillin-resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (CA-MRSA) is an emerging public health concern, particularly in groups traditionally considered at elevated risk, such as men who have sex with men (MSM). Despite this, the local epidemiology and behavioral determinants of CA-MRSA colonization in non-metropolitan regions remain insufficiently examined. This cross-sectional study assessed the prevalence of nasal colonization by CA-MRSA and methicillin-resistant coagulase-negative Staphylococci (MRCoNS) in a sample of 89 men (44 MSM and 45 heterosexual) from the central region of Rio Grande do Sul, Brazil. Nasal swabs were collected for microbiological culture, antimicrobial susceptibility testing, and molecular detection of the \u003cem\u003emecA\u003c/em\u003e and nuc genes through qPCR. Participants completed a self-administered questionnaire addressing sociodemographic information, sexual behaviors, and hygiene practices. Results showed a CA-MRSA prevalence of 20% among heterosexual men and 6.8% among MSM. Heterosexual orientation was identified as a significant risk factor (OR\u0026thinsp;=\u0026thinsp;5.12; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.021), whereas identifying as MSM appeared to be protective (OR\u0026thinsp;=\u0026thinsp;0.20; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021). Post-coital hygiene\u0026mdash;specifically showering after sexual intercourse\u0026mdash;was also found to be an independent protective factor (OR\u0026thinsp;=\u0026thinsp;0.16; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026). These findings challenge the conventional assumption that MSM universally constitute a high-risk group for CA-MRSA colonization. Instead, the higher prevalence detected among heterosexual men in this setting seems linked to individual hygiene behaviors, underscoring the relevance of universal preventive strategies emphasizing post-sex hygiene rather than approaches based solely on sexual orientation.\u003c/p\u003e","manuscriptTitle":"Men Who Have Sex With Men: Sexual Behavior May Not Represent an Increased Risk for Methicillin-Resistant Staphylococcus aureus Colonization","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-07 06:16:40","doi":"10.21203/rs.3.rs-8492252/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8c6cb198-4cb9-40e8-90eb-89055a85110e","owner":[],"postedDate":"January 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-08T16:40:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-07 06:16:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8492252","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8492252","identity":"rs-8492252","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}