Occurrence of Rectal Gonorrhoea and Chlamydia and Antibiotic Susceptibility Profile among Men Who Have Sex with Men at the Kenyan Coast
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Date
2018-10
Authors
Ngetsa, Caroline Jumwa
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
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.
Description
A Research Thesis Submitted In Partial Fulfilment of the Requirements for the Award of the Degree of Master of Science (Infectious Diseases) In the School of Medicine of
Kenyatta University