High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among HIV-1 negative men who have sex with men in coastal Kenya.
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.
Sanders
Eduard J
EJ
Kenya Medical Research Institute, Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, Kenya. esanders@kilifi.kemri-wellcome.org
Thiong'o
Alexander N
AN
Okuku
Haile Selassie
HS
Mwambi
John
J
Priddy
Frances
F
Shafi
Juma
J
de Vries
Henry
H
McClelland
R Scott
RS
Graham
Susan M
SM
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