Gonorrhea and chlamydia prevalence in different anatomical sites among men who have sex with men: a cross-sectional study in Guangzhou, China

Abstract

BackgroundA high rectal and oropharyngeal sexually transmitted infection (STI) burden has been reported among men who have sex with men (MSM) in many regions, but little data exists on rectal and oropharyngeal STIs among MSM in China. The purpose of this study was to determine the prevalence of gonorrhea and chlamydia at different anatomic sites among MSM in Guangzhou, China.MethodsWe recruited a cross-sectional sample of MSM in one Chinese city and collected detailed information about socio-demographic characteristics and sexual behaviors. Men had urine, rectal, and pharyngeal swab samples tested for gonorrhea and chlamydia using nucleic acid amplification tests (NAAT). Univariate and multivariate logistic regressions were used to evaluate factors associated with gonorrhea and chlamydia. Among men without any STI symptoms, we also examined the prevalence of gonorrhea and chlamydia by anatomical site.ResultsWe enrolled 463 men between January 2015 and March 2017. A total of 58/463 (12.5%) of men had gonorrhea and 84/463 (18.1%) had chlamydia. MSM with gonorrhea were more likely to have been recruited from the STI clinic (OR 3.41, 95% CI 1.94–5.99), living with HIV (OR 2.41, 95% CI 1.18–4.92), diagnosed had STI co-infection (OR 2.55, 95% CI 1.39–4.69). MSM with chlamydia were more likely to be students (OR 1.8, 95% CI 0.99–3.39). Most gonorrhea (34/58, 59%) and chlamydia (64/84, 76%) infections were not associated with STI symptoms.ConclusionAsymptomatic gonorrhea and chlamydia infection were common in this sample of Chinese MSM. Further research is necessary to determine optimal STI screening programs.

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

“…This is similar to treating cervical infection (CT/NG) in the vaginal discharge flowchart. The limitations are thus similar with rectal infections, where the majority are asymptomatic . In a small study in Kenya, one in five men with an anorectal CT/NG reported rectal pain ; in Côte d'Ivoire, more than half of the men in the study reported anorectal symptoms in the past 12 months ; in Germany, 12% of 2247 men who have sex with men (MSM) had anorectal CT/NG, and only 12% of these had local symptoms, and 91% of both rectal and pharyngeal CT/NG would have been missed if only symptomatic men had been tested .…”

“…Additionally, the cause of genital ulcer disease (GUD) syndrome has become less by chancroid or syphilis and more by herpes simplex virus (HSV) . With the advent of molecular tests, it has become evident that many more infections exist asymptomatically in both men and women and that the diagnostic accuracy of STI syndromes is low . In addition, the increasing rates of antimicrobial resistance (AMR) in NG and Mycoplasma genitalium (MG) with limited treatment options make it imperative that treatments are based on aetiological diagnosis .…”

STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany

“…The overall prevalence of CT (10.1%) and NG (8.6%) in our study were lower than for MG, but still high, and comparable to other studies among MSM, especially in Western countries. Globally, prevalences varied between 1 and 24% for CT, and 0 and 54% for NG [8,11,[44][45][46][47][48][49][50][51][52][53][54][55], depending on the type of the recruiting institution, clinical symptoms, HIV status and sexual behaviour of the participants. Extragenital as well as asymptomatic infections were reported to be common.…”

Epidemiology of gonorrhoea: a global perspective

“…As expected, test positivity was highest among MSM attending STI clinics: 35% among 229 STI clinic attendees in Guatemala and 22% among 463 men in Guangzhou, China (including 7.2% rectal positivity and 3.9% pharyngeal positivity). 25,26 In over 10 000 MSM tested in 42 STI clinics in the USA during 2010-12, 11.1% tested positive for urethral gonorrhoea, 10.2% tested positive for rectal gonorrhoea and 7.9% tested positive for pharyngeal gonorrhoea. 27 Much lower test positivity was found among MSM who were enrolled in cohort studies or sampled through respondent-driven sampling in Brazil, Thailand, coastal Kenya and Uganda; 1.4-1.8% had urethral gonorrhoea, 1.8-9% had rectal gonorrhoea and 0.5% pharyngeal gonorrhoea at baseline.…”