title: High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among HIV-1 negative men who have sex with men in coastal Kenya.
abstract: OBJECTIVE
  To assess the burden of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in high-risk HIV-1 negative men who have sex with men (MSM) in Africa.
  
  
  METHODS
  Before the start of a pre-exposure prophylaxis trial, HIV-1 negative volunteers were screened for sexually transmitted infection (STI) including CT and NG, using a highly sensitive and specific nucleic acid amplification test. Samples positive for CT by Aptima testing, were evaluated for the presence of lymphogranuloma venereum (LGV) serovars using an in-house PCR assay. All men were asked to submit a urine specimen, and all had a rectal swab collected by a clinician. Men were asked if they had dysuria, urethral or rectal discharge, or rectal pain.
  
  
  RESULTS
  43 HIV-1 negative MSM were screened, of whom 13 reported sex with men only; the majority (27/43) reported sex work. One volunteer had dysuria and another, rectal pain. Eleven MSM (26%, 95% CI 14% to 41%) had infections with either or both pathogens. Homosexual men had a higher prevalence of any infection than bisexual men (46% vs 17%, p=0.04), and all cases of rectal infections, including one with CT, two with NG and two with CT/NG co-infection. All patients with CT were negative for LGV. One patient with a rectal NG infection reported rectal pain.
  
  
  CONCLUSIONS
  A remarkably high burden of STI infection was found among HIV-1 negative MSM. Most (12/13) infections, including three of four rectal NG infections, were subclinical. These findings suggest that high-risk MSM will benefit from effective STI screening in Kenya.
authors.affiliation: Kenya Medical Research Institute, Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, Kenya. esanders@kilifi.kemri-wellcome.org
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Thiong'o
authors.forename: Haile Selassie
authors.initials: HS
authors.lastname: Okuku
authors.forename: John
authors.initials: J
authors.lastname: Mwambi
authors.forename: Frances
authors.initials: F
authors.lastname: Priddy
authors.forename: Juma
authors.initials: J
authors.lastname: Shafi
authors.forename: Henry
authors.initials: H
authors.lastname: de Vries
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology*; D002692:Chlamydia trachomatis; D006069:Gonorrhea / Q000453:epidemiology*; D018023:HIV Seronegativity; D015497:HIV-1; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D009344:Neisseria gonorrhoeae; D015995:Prevalence; D012002:Rectal Diseases / Q000453:epidemiology; D014522:Urethral Diseases / Q000453:epidemiology; D055815:Young Adult