Rectal Gonorrhoea and Chlamydia among Men Who Have Sex with Men in Coastal Kenya
Loading...
Date
2020
Authors
Ngetsa, Caroline J.
Heymann, Marc W.
Thiong'o, Alex
Wahome, Elizabeth
Mwambi, John
Karani, Clara
Menza, Nelson C.
Mwashigadi, Grace
Muturi, Margaret W.
Graham, Susan M.
Journal Title
Journal ISSN
Volume Title
Publisher
Wellcome Open Research
Abstract
Background: Men who have sex with men (MSM) have a higher
prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae
(NG) infections compared to the rest of the population, often remaining
undiagnosed. In Kenya, prevalence of rectal CT and NG infection and NG
antimicrobial sensitivity are poorly described.
Methods: MSM who reported receptive anal intercourse (RAI) were
recruited from an ongoing human immunodeficiency virus acquisition and
treatment study in coastal Kenya in 2016-2017. Rectal swabs were
collected at two time points 6 months apart to estimate prevalence and
incidence of CT/NG infection using a molecular point-of-care assay.
Participants positive for CT or NG were treated according to national
guidelines. NG culture and antimicrobial susceptibility testing was
performed. Participant and risk behaviour characteristics were collected
and association with baseline CT/NG prevalence assessed by multivariable
regression analysis.
Results: Prevalence of CT/NG in 104 MSM was 21.2% (CT 13.5%, NG
9.6%, dual infection 1.9%) at baseline and 25.9% in 81 MSM at follow-up
(CT 14.8%, NG 14.8%, dual infection 3.7%). CT/NG incidence was
estimated at 53.0 (95% CI, 34.5-81.3) per 100 person-years. Most CT/NG positive participants were asymptomatic: 95.5% at baseline and 100% at
follow-up. CT/NG infection was associated with being paid for sex [adjusted
odds ratio (aOR)=6.2, 95% CI (1.7-22.9)] and being in formal employment
[aOR=7.5, 95% CI (1.1-49.2)]. Six NG isolates were obtained at follow-up;
all were susceptible to ceftriaxone and cefixime and all were resistant to
penicillin, tetracycline and ciprofloxacin.
Conclusions: There is a high prevalence and incidence of asymptomatic
rectal CT and NG in MSM reporting RAI in coastal Kenya. MSM who were
paid for sex or had formal employment were more likely to be infected with
CT/NG suggesting increased risk behaviour during transactional sex.
Antimicrobial susceptibility results suggest that current antibiotic choices in
Kenya are appropriate for NG treatment.
Description
An Article Published in Wellcome Open Research
Keywords
Chlamydia, Gonorrhoea, Men Who Have Sex With Men, Kenya, Cefixime, Azithromycin, Antimicrobial Susceptibility