Occurrence of Rectal Gonorrhoea and Chlamydia and Antibiotic Susceptibility Profile among Men Who Have Sex with Men at the Kenyan Coast

Abstract

Men who have sex with men experience a high burden of Chlamydia trachomatis and Neisseria gonorrhoea infections which remain largely undiagnosed in the context of syndromic and presumptive treatment. In Kenya, limited data is available to inform on occurrence and recurrence of rectal chlamydia and gonorrhoea and antibiotic sensitivity on Neisseria gonorrhoea among Men who have sex with men who report receptive anal intercourse. The aim of this study was to determine the occurrence, recurrence and reinfection of rectal Neisseria gonorrhoea and Chlamydia trachomatis infections among Men who have sex at the Kenyan Coast. This study also compared the performance of Gram stain and Gene Xpert in the detection of chlamydia and gonorrhoea and determined the antibiotic sensitivity profile of N. gonorrhoea. The study was carried out in Kemri-Wellcome Trust Program Mtwapa Research clinic employing a longitudinal cohort study design and purposeful sampling technique. Men who had sex with men enrolled in an ongoing larger cohort studies and who reported receptive anal intercourse in the past six months were involved in this study. Three rectal swabs were collected and analysed by Gram stain, culture on Thayer Martin medium and molecular point of care technique by use of the Gene Xpert analyser. All gonorrhoea isolates were subjected to antibiotic sensitivity test. Results in this study were analysed using Stata version 13.0 (Stata Corp LP, college station, United States of America) and significance level set at P<0.05. Out of 104 MSM assessed at baseline, 21% had chlamydia or gonorrhoea, 12% had chlamydia only, 8% had gonorrhoea only and 2% had both chlamydia and gonorrhoea. Out of all the infections detected at baseline, 20% were asymptomatic and had <10 PMN cells (p=0.0039, 95% CI 0.02, 0.015). At 6 months follow-up, 82 (79%) those assessed contributed 39.1 person-years with a median follow-up time of 5.7 (interquartile range: 5.4-6.2). Similar findings of occurrence and recurrence were obtained as of the baseline with a high rate of chlamydia or gonorrhoea infection at 53.7 (95% CI, 35.0– 82.4) per 100 person-years. All isolated N. gonorrhoea were sensitive to ceftriaxone and cefixime, but resistant to ciprofloxacin. chlamydia or gonorrhoea infection was associated with being paid for sex [aOR, 4.2, p=0.01]. Therefore, this study showed a high burden of asymptomatic rectal chlamydia and or gonorrhoea co-infections among MSM at the Coastal Kenya with high recurrence of these infections over time. Gram stain method had very low specificity and sensitivity for rectal gonorrhoea and polymornonuclear neutrophils cells should not be used as indicator for infections in men who have sex with men. Macrolides and third generation cephalosporins antibiotics were highly sensitive to gonorrhoea isolates. The high prevalence of asymptomatic chlamydia and gonorrhoea suggest the need for regular screening or presumptive treatment. Screening by Gene Xpert should be considered as a valuable addition to routine screening of chlamydia and gonorrhoea in healthcare settings and treatment of gonorrhoea. Intervention programs should follow new guidelines that recommend macrolides and third generation cephalosporins and avoid quinolones, tetracyclines and penicillins.