High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among HIV-1 negative men who have sex with men in coastal Kenya

• Published in: Sexually transmitted infections Vol. 86; no. 6; p. 440
• Main Authors: Sanders, Eduard J, Thiong'o, Alexander N, Okuku, Haile Selassie, Mwambi, John, Priddy, Frances, Shafi, Juma, de Vries, Henry, McClelland, R Scott, Graham, Susan M
• Format: Journal Article
• Language: English
• Published: England 01-11-2010
• Subjects: Adult; Chlamydia Infections - epidemiology; Chlamydia trachomatis; Gonorrhea - epidemiology; HIV Seronegativity; HIV-1; Homosexuality, Male - statistics & numerical data; Humans; Kenya - epidemiology; Male; Neisseria gonorrhoeae; Prevalence; Rectal Diseases - epidemiology; Urethral Diseases - epidemiology; Young Adult; Kenya
• ISSN: 1472-3263
• DOI: 10.1136/sti.2010.043224

To assess the burden of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in high-risk HIV-1 negative men who have sex with men (MSM) in Africa.
Before the start of a pre-exposure prophylaxis trial, HIV-1 negative volunteers were screened for sexually transmitted infection (STI) including CT and NG, using a highly sensitive and specific nucleic acid amplification test. Samples positive for CT by Aptima testing, were evaluated for the presence of lymphogranuloma venereum (LGV) serovars using an in-house PCR assay. All men were asked to submit a urine specimen, and all had a rectal swab collected by a clinician. Men were asked if they had dysuria, urethral or rectal discharge, or rectal pain.
43 HIV-1 negative MSM were screened, of whom 13 reported sex with men only; the majority (27/43) reported sex work. One volunteer had dysuria and another, rectal pain. Eleven MSM (26%, 95% CI 14% to 41%) had infections with either or both pathogens. Homosexual men had a higher prevalence of any infection than bisexual men (46% vs 17%, p=0.04), and all cases of rectal infections, including one with CT, two with NG and two with CT/NG co-infection. All patients with CT were negative for LGV. One patient with a rectal NG infection reported rectal pain.
A remarkably high burden of STI infection was found among HIV-1 negative MSM. Most (12/13) infections, including three of four rectal NG infections, were subclinical. These findings suggest that high-risk MSM will benefit from effective STI screening in Kenya.