title: High prevalence of Neisseria gonorrhoeae in a remote, undertreated population of Namibian pastoralists.
abstract: The highly remote pastoralist communities in Kaokoland, Namibia, have long been presumed to have high gonorrhoea prevalence. To estimate gonorrhoea prevalence and correlates of infection, we conducted a cross-sectional study of 446 adults across 28 rural villages. Gonorrhoea status was determined from urethral and vaginal swabs via qPCR assay. All participants answered a closed-ended interview about demographics, sexual behaviour and symptom history. Sixteen per cent of participants had high-level infections (⩾ID(50) dose) and 48% had low-level infections (<ID(50) dose). Women had higher prevalence than men of both high- and low-level infections. High-level infections were regionally and seasonally clustered, occurring in young adults in the Ehama region during the winter. Low-level infections were distributed homogenously across demographic characteristics, season, and region. All low-level infections and most high-level infections (men 78%, women 95%) were asymptomatic and left untreated. The epidemic-like nature of high-level gonorrhoea cases suggests that intervention efforts can be focused on seasons of high social activity.
authors.affiliation: School of Natural Resources and Environment,University of Michigan,MI,USA.
authors.forename: A
authors.initials: A
authors.lastname: Hazel
authors.affiliation: Department of Epidemiology,University of Michigan,MI,USA.
authors.forename: S
authors.initials: S
authors.lastname: Ponnaluri-Wears
authors.affiliation: Department of Epidemiology,University of Michigan,MI,USA.
authors.forename: G S
authors.initials: GS
authors.lastname: Davis
authors.affiliation: School of Natural Resources and Environment,University of Michigan,MI,USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Low
authors.affiliation: Department of Epidemiology,University of Michigan,MI,USA.
authors.forename: B
authors.initials: B
authors.lastname: Foxman
mesh_terms: D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D004269:DNA, Bacterial / Q000032:analysis; D003906:Developing Countries; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009276:Namibia / Q000453:epidemiology; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods; D011203:Poverty; D015995:Prevalence; D011634:Public Health; D018570:Risk Assessment; D012424:Rural Population; D012720:Severity of Illness Index; D017678:Sex Distribution; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial