Sexually transmitted infections amongst men who have sex with men (MSM) in South Africa

Abstract

There is limited data about bacterial STIs in MSM populations in sub-Saharan Africa. Our retrospective analysis used data from the HVTN 702 HIV vaccine clinical trial (October 2016 to July 2021). We evaluated multiple variables. Polymerase chain reaction testing was conducted on urine and rectal samples to detect Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) every 6 months. Syphilis serology was conducted at month 0 and thereafter every 12 months. We calculated STI prevalence and the associated 95% confidence intervals until 24 months of follow-up. The trial enrolled 183 participants who identified as male or transgender female, and of homosexual or bisexual orientation. Of these, 173 had STI testing done at month 0, median age was 23 (IQR 20–25) years, with median 20.5 (IQR 17.5–24.8) months follow-up (FU). The clinical trial also enrolled and performed month 0 STI testing on 3389 female participants, median age 23 (IQR 21–27) years, median 24.8 (IQR 18.8–24.8) months FU and 1080 non-MSM males with a median age of 27 (IQR 24–31) years, median 24.8 (IQR 23–24.8) months FU. At month 0, CT prevalence was similar in MSM and females (26.0% vs 23.0%, p = 0.492) but was more prevalent in MSM compared to non-MSM males (26.0% vs 14.3%, p = 0.001). CT was the most prevalent STI among MSM at months 0 and 6 but declined from month 0 to month 6 (26.0% vs 17.1%, p = 0.023). In contrast, NG did not decline in MSM between months 0 and 6 (8.1% vs 7.1%, p = 0.680) nor did syphilis prevalence between months 0 and 12 (5.2% vs 3.8%, p = 0.588). Bacterial STI burden is higher in MSM compared to non-MSM males, and CT is the most prevalent bacterial STI amongst MSM. Preventive STI vaccines, especially against CT, may be helpful to develop.

Extragenital Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men in Johannesburg, South Africa

“…This was highlighted in the first systematic review and meta-analysis of global syphilis prevalence in this key population, in which sub-Saharan Africa contributed only 7% of the data points during the 20-year survey period. 35s A limited number of South African studies have conducted syphilis testing among MSM, with results revealing seroprevalences ranging from 5.2%, 14 11% (MSM), 8 and 12.5% (MSM and transgender women) 6 to 21.6% (MSM) 3 . The latter findings are in keeping with the RPR seropositivity observed in our cohort.…”

“…The high rates of asymptomatic rectal STIs we observed mirror rectal gonorrhea and/or chlamydia prevalence rates detected by others 3,6 . In contrast to other studies in our country, CT was not the predominant rectal pathogen 14 . Studies have demonstrated low LGV positivity rates (<5%) among MSM positive for rectal CT infection, 22–24 and hence, our small sample size may have contributed to the failure to detect this bacterial pathogen.…”

“…We failed to find additional factors associated with having an extragenital STI, including those regularly reported such as a younger age (often ≤25 years), 3,14 multiple sexual partners, 8 and transactional sex, 3,8 whereas factors such as PrEP use are still subject to debate. 34s This may be a consequence of our limited sample size and the relatively narrow age range of our participants.…”

“…Although some studies have assessed non-HIV STI prevalence among South African MSM, these have included MSM with urethral symptoms 12,13 ; were restricted to Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) molecular testing, 3,14 and pharyngeal infections remain insufficiently explored 8 . A recent study by Le Roux et al, 4 provided a comprehensive analysis of 4 nonviral STIs at urethral, rectal, and pharyngeal sites among 200 MSM in Tshwane, although syphilis serological testing was not performed.…”

State of Knowledge on Sexually Transmitted Infections among Health Professionals and Health Sciences Students in France

“…Additionally, the studies reveal that the bacterial STI burden is greater in MSM compared to non-MSM males, emphasizing the need for tailored healthcare services for MSM. STI prevalence among MSM also seem to remain relatively stable over time [67]. Men who have sex with men (MSM) and participate in unprotected anal intercourse with casual partners face a significant risk of contracting sexually transmitted infections (STIs).…”