A cross sectional analysis of Gonococcal and Chlamydial infections among men-who-have-sex-with-men in Cape Town, South Africa

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dc.contributor.authorRebe, Kevinen_ZA
dc.contributor.authorLewis, Daviden_ZA
dc.contributor.authorMyer, Landonen_ZA
dc.contributor.authorde Swardt, Glennen_ZA
dc.contributor.authorStruthers, Helenen_ZA
dc.contributor.authorKamkuemah, Monikaen_ZA
dc.contributor.authorMcIntyre, Jamesen_ZA
dc.date.accessioned2015-12-20T16:05:18Z
dc.date.available2015-12-20T16:05:18Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: Men-who-have-sex-with-men (MSM) are at high risk of HIV and sexually transmitted infection (STI) transmission. Asymptomatic STIs are common in MSM and remain undiagnosed and untreated where syndromic management is advocated. Untreated STIs could be contributing to high HIV rates. This study investigated symptomatic (SSTI) and asymptomatic STIs (ASTIs) in MSM in Cape Town. METHODS: MSM, 18 years and above, were enrolled into this study. Participants underwent clinical and microbiological screening for STIs. Urine, oro-pharyngeal and anal swab specimens were collected for STI analysis, and blood for HIV and syphilis screening. A psychosocial and sexual questionnaire was completed. STI specimens were analysed for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infection. RESULTS: 200 MSM were recruited with a median age of 32 years (IQR 26-39.5). Their median number of sex partners within the last year was 5 (IQR 2-20). 155/200 (78%) reported only male sex partners while 45/200 (23%) reported sex with men and women. 77/200 (39%) reported transactional sex. At enrolment, 88/200 (44%) were HIV positive and 8/112 (7%) initially HIV-negative participants seroconverted during the study. Overall, 47/200 (24%) screened positive for either NG or CT. There were 32 MSM (16%) infected with NG and 7 (3.5%) of these men had NG infections at two anatomical sites (39 NG positive results in total). Likewise, there were 23 MSM (12%) infected with CT and all these men had infections at only one site. Eight of the 47 men (17%) were infected with both NG and CT. ASTI was more common than SSTI irrespective of anatomical site, 38 /200 (19%) versus 9/200 (5%) respectively (p<0.001). The anus was most commonly affected, followed by the oro-pharynx and then urethra. Asymptomatic infection was associated with transgender identity (OR 4.09 CI 1.60-5.62), ≥5 male sex partners in the last year (OR 2.50 CI 1.16-5.62) and transactional sex (OR 2.33 CI 1.13-4.79) but not with HIV infection. CONCLUSIONS: Asymptomatic STI was common and would not have been detected using a syndromic management approach. Although molecular screening for NG/CT is costly, in our study only four MSM needed to be screened to detect one case. This supports dual NG/CT molecular screening for MSM, which, in the case of confirmed NG infections, may trigger further culture-based investigations to determine gonococcal antimicrobial susceptibility in the current era of multi-drug resistant gonorrhoea.en_ZA
dc.identifier.apacitationRebe, K., Lewis, D., Myer, L., de Swardt, G., Struthers, H., Kamkuemah, M., & McIntyre, J. (2015). A cross sectional analysis of Gonococcal and Chlamydial infections among men-who-have-sex-with-men in Cape Town, South Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/15920en_ZA
dc.identifier.chicagocitationRebe, Kevin, David Lewis, Landon Myer, Glenn de Swardt, Helen Struthers, Monika Kamkuemah, and James McIntyre "A cross sectional analysis of Gonococcal and Chlamydial infections among men-who-have-sex-with-men in Cape Town, South Africa." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/15920en_ZA
dc.identifier.citationRebe, K., Lewis, D., Myer, L., de Swardt, G., Struthers, H., Kamkuemah, M., & McIntyre, J. (2015). A cross sectional analysis of Gonococcal and Chlamydial infections among men-who-have-sex-with-men in Cape Town, South Africa. PloS one, 10(9), e0138315. doi:10.1371/journal.pone.0138315en_ZA
dc.identifier.ris TY - Journal Article AU - Rebe, Kevin AU - Lewis, David AU - Myer, Landon AU - de Swardt, Glenn AU - Struthers, Helen AU - Kamkuemah, Monika AU - McIntyre, James AB - BACKGROUND: Men-who-have-sex-with-men (MSM) are at high risk of HIV and sexually transmitted infection (STI) transmission. Asymptomatic STIs are common in MSM and remain undiagnosed and untreated where syndromic management is advocated. Untreated STIs could be contributing to high HIV rates. This study investigated symptomatic (SSTI) and asymptomatic STIs (ASTIs) in MSM in Cape Town. METHODS: MSM, 18 years and above, were enrolled into this study. Participants underwent clinical and microbiological screening for STIs. Urine, oro-pharyngeal and anal swab specimens were collected for STI analysis, and blood for HIV and syphilis screening. A psychosocial and sexual questionnaire was completed. STI specimens were analysed for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infection. RESULTS: 200 MSM were recruited with a median age of 32 years (IQR 26-39.5). Their median number of sex partners within the last year was 5 (IQR 2-20). 155/200 (78%) reported only male sex partners while 45/200 (23%) reported sex with men and women. 77/200 (39%) reported transactional sex. At enrolment, 88/200 (44%) were HIV positive and 8/112 (7%) initially HIV-negative participants seroconverted during the study. Overall, 47/200 (24%) screened positive for either NG or CT. There were 32 MSM (16%) infected with NG and 7 (3.5%) of these men had NG infections at two anatomical sites (39 NG positive results in total). Likewise, there were 23 MSM (12%) infected with CT and all these men had infections at only one site. Eight of the 47 men (17%) were infected with both NG and CT. ASTI was more common than SSTI irrespective of anatomical site, 38 /200 (19%) versus 9/200 (5%) respectively (p<0.001). The anus was most commonly affected, followed by the oro-pharynx and then urethra. Asymptomatic infection was associated with transgender identity (OR 4.09 CI 1.60-5.62), ≥5 male sex partners in the last year (OR 2.50 CI 1.16-5.62) and transactional sex (OR 2.33 CI 1.13-4.79) but not with HIV infection. CONCLUSIONS: Asymptomatic STI was common and would not have been detected using a syndromic management approach. Although molecular screening for NG/CT is costly, in our study only four MSM needed to be screened to detect one case. This supports dual NG/CT molecular screening for MSM, which, in the case of confirmed NG infections, may trigger further culture-based investigations to determine gonococcal antimicrobial susceptibility in the current era of multi-drug resistant gonorrhoea. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0138315 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - A cross sectional analysis of Gonococcal and Chlamydial infections among men-who-have-sex-with-men in Cape Town, South Africa TI - A cross sectional analysis of Gonococcal and Chlamydial infections among men-who-have-sex-with-men in Cape Town, South Africa UR - http://hdl.handle.net/11427/15920 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15920
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0138315
dc.identifier.vancouvercitationRebe K, Lewis D, Myer L, de Swardt G, Struthers H, Kamkuemah M, et al. A cross sectional analysis of Gonococcal and Chlamydial infections among men-who-have-sex-with-men in Cape Town, South Africa. PLoS One. 2015; http://hdl.handle.net/11427/15920.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2015 Rebe et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherMen who have sex with menen_ZA
dc.subject.otherChlamydia infectionen_ZA
dc.subject.otherSexually transmitted diseasesen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherHIV clinical manifestationsen_ZA
dc.subject.otherSyphilisen_ZA
dc.subject.otherHIV preventionen_ZA
dc.titleA cross sectional analysis of Gonococcal and Chlamydial infections among men-who-have-sex-with-men in Cape Town, South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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