Urogenital Chlamydia trachomatis Infections among Ethnic Groups in Paramaribo, Suriname; Determinants and Ethnic Sexual Mixing Patterns

Abstract

BackgroundLittle is known about the epidemiology of urogenital Chlamydia trachomatis infection (chlamydia) in Suriname. Suriname is a society composed of many ethnic groups, such as Creoles, Maroons, Hindustani, Javanese, Chinese, Caucasians, and indigenous Amerindians. We estimated determinants for chlamydia, including the role of ethnicity, and identified transmission patterns and ethnic sexual networks among clients of two clinics in Paramaribo, Suriname.MethodsParticipants were recruited at two sites a sexually transmitted infections (STI) clinic and a family planning (FP) clinic in Paramaribo. Urine samples from men and nurse-collected vaginal swabs were obtained for nucleic acid amplification testing. Logistic regression analysis was used to identify determinants of chlamydia. Multilocus sequence typing (MLST) was performed to genotype C. trachomatis. To identify transmission patterns and sexual networks, a minimum spanning tree was created, using full MLST profiles. Clusters in the minimum spanning tree were compared for ethnic composition.ResultsBetween March 2008 and July 2010, 415 men and 274 women were included at the STI clinic and 819 women at the FP clinic. Overall chlamydia prevalence was 15% (224/1508). Age, ethnicity, and recruitment site were significantly associated with chlamydia in multivariable analysis. Participants of Creole and Javanese ethnicity were more frequently infected with urogenital chlamydia. Although sexual mixing with other ethnic groups did differ significantly per ethnicity, this mixing was not independently significantly associated with chlamydia. We typed 170 C. trachomatis-positive samples (76%) and identified three large C. trachomatis clusters. Although the proportion from various ethnic groups differed significantly between the clusters (P = 0.003), all five major ethnic groups were represented in all three clusters.ConclusionChlamydia prevalence in Suriname is high and targeted prevention measures are required. Although ethnic sexual mixing differed between ethnic groups, differences in prevalence between ethnic groups could not be explained by sexual mixing.

Cross-sectional study of genital carcinogenic HPV infections in Paramaribo, Suriname: prevalence and determinants in an ethnically diverse population of women in a pre-vaccination era

“…Participants had been recruited at two sites in Paramaribo, Suriname, as part of a previous study9: The Dermatological Service, an integrated outpatient sexually transmitted infections (STI) clinic frequented by men and women, offering free-of-charge examination and treatment of STIs and infectious skin diseases. All women who visited for a STI check-up were invited to participate in the study.…”

“…A recent study showed that the prevalence of Chlamydia trachomatis differed between ethnic groups in Suriname 9. The same might be true for the prevalence of carcinogenic HPV infection, as ethnic disparities in the prevalence of premalignant cervical lesions have been described 10.…”

Global Multilocus Sequence Type Analysis of Chlamydia trachomatis Strains from 16 Countries

“…The third scheme was developed by Klint et al (10); it is intended for short-term clinical epidemiology and outbreak investigations and is based on five highly variable genomic loci (hctB [CT046], CT058, CT144, CT172, and pbpB [CT682]). The MLST scheme has been slightly modified to facilitate rational processing with only 1% loss of discriminatory capacity (13), and the current setup can be found at the Uppsala University C. trachomatis MLST database (http: //mlstdb.bmc.uu.se).Since its development in 2007, the scheme has been applied to a variety of clinical specimens, including samples from cases of urogenital chlamydia (7,(13)(14)(15)(16)(17)(18)(19)(20)(21), LGV (22,23), and trachoma (24). It has been useful for different purposes: (i) identification of clonal spread of LGV (22) …”

“…Since its development in 2007, the scheme has been applied to a variety of clinical specimens, including samples from cases of urogenital chlamydia (7,(13)(14)(15)(16)(17)(18)(19)(20)(21), LGV (22,23), and trachoma (24). It has been useful for different purposes: (i) identification of clonal spread of LGV (22) …”

“…Since its development in 2007, the scheme has been applied to a variety of clinical specimens, including samples from cases of urogenital chlamydia (7,(13)(14)(15)(16)(17)(18)(19)(20)(21), LGV (22,23), and trachoma (24). It has been useful for different purposes: (i) identification of clonal spread of LGV (22) and the new variant of C. trachomatis (16,17); (ii) differentiation of strains within the predominating serotype, E (7,17); (iii) differentiation of strains infecting men who have sex with men (MSM) and heterosexuals (15,19); (iv) investigation of the role of tissue tropism (21); and (v) molecular epidemiology and antibiotic treatment of trachoma (24).…”