Evaluation of WHO screening algorithm for the presumptive treatment of asymptomatic rectal gonorrhoea and chlamydia infections in at-risk MSM in Kenya

Abstract

ObjectivesThe WHO recommends that men who have sex with men (MSM) reporting unprotected receptive anal intercourse (RAI) and either multiple partners or a partner with a sexually transmitted infection (STI) in the past 6 months should be presumptively treated for asymptomatic rectal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections. We evaluated this recommendation in a cohort of ‘high-risk’ MSM in Coastal Kenya.MethodsWe assessed presence of genitourinary and rectal symptoms, and determined prevalence and 3-month incidence of rectal NG and CT infections. We performed nucleic acid amplification testing of urine and rectal swab samples collected from MSM followed prospectively, and assessed predictive values of the WHO algorithm at baseline screening.ResultsOf 244 MSM screened, 240 (98.4%) were asymptomatic, and 147 (61.3%) reported any RAI in the past 6 months. Among 85 (35.4%) asymptomatic MSM meeting criteria for the WHO presumptive treatment (PT) recommendation, we identified 20 with rectal infections (six NG, 12 CT and two NG–CT co-infections). Among 62 asymptomatic MSM who did not meet criteria, we identified seven who were infected. The sensitivity and specificity of the WHO algorithm were 74.1% (95% CI 53.7% to 88.9%) and 45.8% (95% CI 36.7% to 55.2%), respectively. The 3-month incidence of any rectal NG or CT infection in asymptomatic men reporting any RAI was 39.7 (95% CI 24.3 to 64.8) per 100 person-years.ConclusionsAbout one-third of asymptomatic MSM were eligible to receive PT for NG and CT infections. Among MSM who would qualify for PT of rectal STIs, the number needed to treat in order to treat one infection was four. Our results support the value of the WHO screening algorithm and recommended PT strategy in this population.

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

“…The high incidence of STIs in this cohort is higher than has been previously reported among MSM, 9, 21 . This high incidence of STIs highlights the importance of STI screening among MSM in order to curb the spread of these infections.…”

“…Routine laboratory-based STI screening is an important strategy to prevent further transmission of GC, CT and HIV, 9 . Early detection and treatment of asymptomatic STIs prevents onward transmission.…”

“…A prior study with MSM in Nigeria estimated a GC prevalence of 23% and CT prevalence of 16%, 8 . To date, few studies have documented incidence of these infections, 9 which indicates the current trend of the epidemics. Studies on incidence of STIs are important as they contribute to our understanding of infection risks and the STI epidemic dynamics among gay men and other MSM.…”

Women Who Have Sex with Women in Kenya and Their Sexual and Reproductive Health

“…To date, available public health literature on gays and lesbians in Kenya has focused exclusively on men who have sex with men (MSM) to the exclusion of WSW. [1][2][3][4][5][6][7] Data on HIV and sexually transmitted infection (STI) transmission in Kenya have included only MSM and heterosexuals. [8][9][10] Lack of research on WSW in comparison to heterosexual men and women, as well as MSM, in general, can be attributed to perceived lower-risk of HIV infection or STIs among WSW.…”

Emerging themes for sensitivity training modules of African healthcare workers attending to men who have sex with men: a systematic review

“…(A) Wahome 31 2013 AIDS Kenya Cohort 641 Fever, diarrhoea, symptomatic STI, fatigue, age 18–29 years, and discordant HIV test results were independent predictors of acute and early HIV-1 acquisition in high risk MSM. (A) Sanders 37 2014 Sex Transm Infect Kenya Cohort 147 Number needed to treat in WHO presumptive treatment recommendation for one asymptomatic NG/CT infection in MSM meeting criteria is 4. (A) Buchbinder 35 2014 Lancet Infect Dis Brazil, Ecuador, Peru, South Africa, Thailand, USA RCT 2499 PAF for unprotected RAI for HIV acquisition in MSM and transgender women was high (64%) and NNT for PrEP to prevent infection was relatively low (36%).…”