Incident gonorrhoea and chlamydia among a prospective cohort of men who have sex with men in Kisumu, Kenya

Abstract

ObjectiveSTIs disproportionately affect men who have sex with men (MSM) in sub-Saharan Africa. We identified factors associated with incident Chlamydiatrachomatis (CT) and Neisseriagonorrhoeae (NG) infections among MSM in the Anza Mapema cohort study in Kisumu, Kenya.MethodsWe enrolled 711 MSM who underwent HIV testing and counselling, medical history and examination, and collection of demographic and behavioural information. They also provided urine and rectal swab specimens for CT and NG testing by qualitative PCR at baseline and at months 6 and 12. Separate multivariable Cox regression models identified factors associated with first incident urethral or rectal infection.ResultsAmong the 619 men aged 18–54 years included in this analysis, there were 83 first incident urethral CT/NG infections (14.4 cases per 100 person-years (PY)) and 40 first incident rectal infections (6.84 cases per 100 PY), and an overall incidence of 18.0 cases per 100 PY (95% CI 14.8 to 21.8). Most urethral (84%) and rectal (81%) infections were asymptomatic. In the adjusted model, the risk of first incident urethral CT/NG decreased by 4% for each 1-year increase in age and was 41% lower for men who reported their partner used condom at last sexual encounter. Men who were HIV-positive had a 68% less risk of urogenital CT/NG compared with those who were negative. Men who reported being usually receptive or versatile as compared with usually insertive had an 81% increased risk of incident urogenital CT/NG.ConclusionOur study demonstrated a high incidence of urethral CT/NG infection, with somewhat lower incidence of rectal CT/NG infection, despite repeated testing and treatment, highlighting the need for preventive interventions to decrease the burden of CT/NG among Kenyan MSM. Most infections were asymptomatic, and routine aetiological screening for STIs is recommended.

Increased Risk of Sexually Transmitted Infections in Men Who Have Sex With Men Taking Preexposure Prophylaxis: A Meta-analysis

“…As for the incidence density of gonorrhea and chlamydia infection, the study showed that the incidence of gonorrhea in MSM was 15.6 to 21.1 per 100 PY, and chlamydia infection was 19.3 to 19.5 per 100 PY 27,35 . Some studies provided the combined incidence density of gonorrhea and chlamydia infection of 18.0 to 33.1 per 100 PY, 36,37 which was lower than the results of our study. Men who have sex with men taking PrEP have high incidence of STIs, which may be due to these factors: that PrEP helps to reduce the acquisition of HIV may increase more high-risk sexual behaviors in MSM such as multiple sexual partners, the decrease in condom use, and more frequent and more vigorous sexual activity 22,38 .…”

Decrease in incidence of sexually transmitted infections symptoms in men who have sex with men enrolled in a quarterly HIV prevention and care programme in West Africa (CohMSM ANRS 12324—Expertise France)

“…8 9 11 By comparison, the incidence of urethral and/or rectal gonorrhoea and/or chlamydia was 19.8 per 100 PY over a 1-year study period in Kenyan MSM using laboratory tests. 11 In South Africa, the incidence of urethral and rectal infections was 14.6 and 29.7 per 100 PY for chlamydia and 8.0 and 19.1 per 100 PY for gonorrhoea, respectively, over a similar study period and also using laboratory tests. 12 In our study, the overall incidence of gonorrhoea and chlamydia could be higher because we did not use laboratory tests and urethral or anal discharges (ie, indications for gonorrhoea and chlamydia) represented 80% of STI symptoms.…”

“…STI symptoms incidence was lower in HIV-positive participants than in their HIV-negative counterparts, which reflects results from the Kenyan study. 11 This would appear to run counter to the fact that HIV-positive participants were more likely to report risky sexual behaviours-such as multiple male sexual partners and inconsistent condom use during anal sex-at study enrolment in CohMSM. However, this apparent paradox could be accounted for by the fact that the psychological impact of the announcement of seropositivity together with the positive effect of repeated counselling, may have led to a greater reduction in risky sexual behaviours in HIV-positive participants than in their HIV-negative counterparts during follow-up.…”

Prevalence and determinants of high-risk human papilloma virus among men who have sex with men in Benin: a cross-sectional study embedded in a demonstration project on pre-exposure prophylaxis against HIV

“…In this study, the aPR (95% CI) for this association was 1.93 (1.31 to 2.83). Since the rectal mucosa is composed of a single-layer columnar epithelium, the microabrasions during anal sex could occur directly through frictions or indirectly through other STIs that are generally associated with anal sex among MSM 27 28. In the current study, MSM were generally well educated.…”