title: Evaluation of WHO screening algorithm for the presumptive treatment of asymptomatic rectal gonorrhoea and chlamydia infections in at-risk MSM in Kenya.
abstract: OBJECTIVE
  The WHO recommends that men who have sex with men (MSM) reporting unprotected receptive anal intercourse (RAI) and either multiple partners or a partner with a sexually transmitted infection (STI) in the past 6 months should be presumptively treated for asymptomatic rectal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections. We evaluated this recommendation in a cohort of 'high-risk' MSM in Coastal Kenya.
  
  
  METHODS
  We assessed presence of genitourinary and rectal symptoms, and determined prevalence and 3-month incidence of rectal NG and CT infections. We performed nucleic acid amplification testing of urine and rectal swab samples collected from MSM followed prospectively, and assessed predictive values of the WHO algorithm at baseline screening.
  
  
  RESULTS
  Of 244 MSM screened, 240 (98.4%) were asymptomatic, and 147 (61.3%) reported any RAI in the past 6 months. Among 85 (35.4%) asymptomatic MSM meeting criteria for the WHO presumptive treatment (PT) recommendation, we identified 20 with rectal infections (six NG, 12 CT and two NG-CT co-infections). Among 62 asymptomatic MSM who did not meet criteria, we identified seven who were infected. The sensitivity and specificity of the WHO algorithm were 74.1% (95% CI 53.7% to 88.9%) and 45.8% (95% CI 36.7% to 55.2%), respectively. The 3-month incidence of any rectal NG or CT infection in asymptomatic men reporting any RAI was 39.7 (95% CI 24.3 to 64.8) per 100 person-years.
  
  
  CONCLUSIONS
  About one-third of asymptomatic MSM were eligible to receive PT for NG and CT infections. Among MSM who would qualify for PT of rectal STIs, the number needed to treat in order to treat one infection was four. Our results support the value of the WHO screening algorithm and recommended PT strategy in this population.
authors: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), , Kilifi, Kenya.
authors: Eduard J
authors: EJ
authors: Sanders
authors: Elizabeth
authors: E
authors: Wahome
authors: Haile Selassie
authors: HS
authors: Okuku
authors: Alexander N
authors: AN
authors: Thiong'o
authors: Adrian D
authors: AD
authors: Smith
authors: Sarah
authors: S
authors: Duncan
authors: John
authors: J
authors: Mwambi
authors: Juma
authors: J
authors: Shafi
authors: R Scott
authors: RS
authors: McClelland
authors: Susan M
authors: SM
authors: Graham
mesh_terms: D000328:Adult; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D006069:Gonorrhea / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D021141:Nucleic Acid Amplification Techniques; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012002:Rectal Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control; D012007:Rectum / Q000382:microbiology; D012680:Sensitivity and Specificity; D012747:Sexual Partners; D014944:World Health Organization
chemical_list: D000900:Anti-Bacterial Agents
keywords: CHLAMYDIA TRACHOMATIS; MEN; NEISSERIA GONORRHOEA; PUBLIC HEALTH; TREATMENT