A Cross Sectional Analysis of Gonococcal and Chlamydial Infections among Men-Who-Have-Sex-with-Men in Cape Town, South Africa

Abstract

BackgroundMen-who-have-sex-with-men (MSM) are at high risk of HIV and sexually transmitted infection (STI) transmission. Asymptomatic STIs are common in MSM and remain undiagnosed and untreated where syndromic management is advocated. Untreated STIs could be contributing to high HIV rates. This study investigated symptomatic (SSTI) and asymptomatic STIs (ASTIs) in MSM in Cape Town.MethodsMSM, 18 years and above, were enrolled into this study. Participants underwent clinical and microbiological screening for STIs. Urine, oro-pharyngeal and anal swab specimens were collected for STI analysis, and blood for HIV and syphilis screening. A psychosocial and sexual questionnaire was completed. STI specimens were analysed for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infection.Results200 MSM were recruited with a median age of 32 years (IQR 26–39.5). Their median number of sex partners within the last year was 5 (IQR 2–20). 155/200 (78%) reported only male sex partners while 45/200 (23%) reported sex with men and women. 77/200 (39%) reported transactional sex. At enrolment, 88/200 (44%) were HIV positive and 8/112 (7%) initially HIV-negative participants seroconverted during the study. Overall, 47/200 (24%) screened positive for either NG or CT. There were 32 MSM (16%) infected with NG and 7 (3.5%) of these men had NG infections at two anatomical sites (39 NG positive results in total). Likewise, there were 23 MSM (12%) infected with CT and all these men had infections at only one site. Eight of the 47 men (17%) were infected with both NG and CT. ASTI was more common than SSTI irrespective of anatomical site, 38 /200 (19%) versus 9/200 (5%) respectively (p<0.001). The anus was most commonly affected, followed by the oro-pharynx and then urethra. Asymptomatic infection was associated with transgender identity (OR 4.09 CI 1.60–5.62), ≥5 male sex partners in the last year (OR 2.50 CI 1.16–5.62) and transactional sex (OR 2.33 CI 1.13–4.79) but not with HIV infection.ConclusionsAsymptomatic STI was common and would not have been detected using a syndromic management approach. Although molecular screening for NG/CT is costly, in our study only four MSM needed to be screened to detect one case. This supports dual NG/CT molecular screening for MSM, which, in the case of confirmed NG infections, may trigger further culture-based investigations to determine gonococcal antimicrobial susceptibility in the current era of multi-drug resistant gonorrhoea.

Substance Use and HIV Risk Among Men Who Have Sex With Men in Africa: A Systematic Review

“…17,19,39,55–57 The proportions of men reporting sex under the influence of alcohol varied from 47.3% (Cape Town, South Africa) to 77.5% (Nairobi, Kenya). 17 Park et al 56 reported that 66.1% of the men had sexual intercourse after drinking alcohol in past 12 months (Cameroon); Rispel et al 19 reported that almost three-quarters (73.4%) of participants reported having sex while under the influence of alcohol.…”

“…42 Use of other specific drugs was less frequently reported; Lane et al 23 reported on use of ecstasy (4.0%); GHB (Gamma Hydroxybutyrate; 0.3%); methamphetamine: (“tik”; 0.3%), methaqualone (“mandrax”; 1.9%), methcathinone (“cat”; 0.3%), and nyaupe (cannabis and heroin; 1.3%), suggesting that use of such drugs is rare. However, Rebe et al 55 reported that 37% of MSM patients at a health clinic in Cape Town reported ever having used crystal methamphetamine; use was much lower among Black MSM compared to White and Coloured/other MSM (19%, 32%, and 57%, respectively). Use of specific drugs varied within countries; Nalá et al 49 reported prevalence of cannabis use in the preceding 12 months among MSM in Mozambique ranging from 4.0% (Nampula/Nacala) to 11.8% (Maputo).…”

“…Among patients in a men’s clinic, ever having had sex under the influence of drugs was less frequently reported by Black MSM compared to White and Coloured/other MSM (23%, 63%, and 69%, respectively). 55 Without further specification, Gebreyesus and Mariam 70 reported that the sexual activities that their participants engaged in were mostly accompanied by the use of drugs (including alcohol). Williams et al 38 reported that the most commonly used substances during sex in 3475 drug-using MSM were cannabis: 65.7%, methamphetamine: 12.7%, and ecstasy 7.4%; other drugs, including heroin and cocaine, were reported in relation to sex by less than 5% of the men (alcohol was reported by 42.6%).…”

“…Use of crystal methamphetamine and sex under the influence of drugs were both found to be associated with asymptomatic STIs [OR (95% CI): 1.8 (0.88–3.70) and 1.59 (0.77–3.29), respectively]. 55 …”

Sexual partner characteristics and incident rectalNeisseria gonorrhoeaeandChlamydia trachomatisinfections among gay men and other men who have sex with men (MSM): a prospective cohort in Abuja and Lagos, Nigeria

“…Among the prior cross-sectional studies, individual-level factors such as multiple sex partners, engaging in transactional sex, inconsistent condom use, and alcohol use were associated with prevalent, 10, 11 . Risk for STIs cannot be attributed to a single factor, but rather a combination of factors that may include risks associated with specific characteristics of an individual’s sexual partnerships.…”