High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in anal and pharyngeal sites among a community-based sample of men who have sex with men and transgender women in Lima, Peru

Segundo R Leon, Eddy R Segura, Kelika A Konda, Juan A Flores, Alfonso Silva-Santisteban, Jerome T Galea, Thomas J Coates, Jeffrey D Klausner, Carlos F Caceres, Segundo R Leon, Eddy R Segura, Kelika A Konda, Juan A Flores, Alfonso Silva-Santisteban, Jerome T Galea, Thomas J Coates, Jeffrey D Klausner, Carlos F Caceres

Abstract

Objectives: This study aimed to characterise the epidemiology of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru.

Setting: Cross-sectional study in Lima, Peru.

Participants: We recruited a group of 510 MSM and 208 TW for a subsequent community-based randomised controlled trial. The presence of CT and NG were evaluated using Aptima Combo2 in pharyngeal and anal swabs. We also explored correlates of these infections.

Primary and secondary outcome measures: Study end points included overall prevalence of C. trachomatis and N. gonorrhoeae in anal and pharyngeal sites.

Results: Overall prevalence of CT was 19% (95% CI 16.1% to 22.1%) and 4.8% (95% CI 3.3% to 6.6%) in anal and pharyngeal sites, respectively, while prevalence of NG was 9.6% (95% CI 7.5% to 12.0%) and 6.5% (95% CI 4.8% to 8.5%) in anal and pharyngeal sites, respectively.

Conclusions: The prevalence of each infection declined significantly among participants older than 34 years (p<0.05). Efforts towards prevention and treatment of extraurogenital chlamydial and gonococcal infections in high-risk populations like MSM and TW in Lima, Peru, are warranted.

Trial registration number: NCT00670163; Results.

Keywords: PUBLIC HEALTH.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Trends of prevalence of anal and pharyngeal infections over age group, satisfied by agent and sexual identity.

References

    1. WHO. Prevalence and incidence in 2005 of selected sexually transmitted infections: methods and results. Geneva: WHO, 2011.
    1. Organization W.H. Guidelines for the management of sexually transmitted infections. Geneva: World Health Organization, 2003.
    1. Organization W.H. Sexually transmitted diseases: three hundred and thirty-three million new, curable cases in 1995 [press release]. Geneva: WHO, 1995.
    1. Detels R, Green AM, Klausner JD et al. . The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries. Sex Transm Dis 2011;38:503–9.
    1. Sweet RL. Pelvic inflammatory disease: current concepts of diagnosis and management. Curr Infect Dis Rep 2012:14:194–203. 10.1007/s11908-012-0243-y
    1. Hamasuna R, Takahashi S, Uehara S et al. . Should urologists care for the pharyngeal infection of Neisseria gonorrhoeae or Chlamydia trachomatis when we treat male urethritis? J Infect Chemother 2012;18:410–13. 10.1007/s10156-011-0355-6
    1. Marcus JL, Kohn RP Barry PM et al. . Chlamydia trachomatis and Neisseria gonorrhoeae transmission from the female oropharynx to the male urethra. Sex Transm Dis 2011;38:372–3. 10.1097/OLQ.0b013e3182029008
    1. Peters RP, Verweij SP, Nijsten N et al. . Evaluation of sexual history-based screening of anatomic sites for chlamydia trachomatis and neisseria gonorrhoeae infection in men having sex with men in routine practice. BMC Infect Dis 2011;11:203 10.1186/1471-2334-11-203
    1. Edwards S, Carne C. Oral sex and transmission of non-viral STIs. Sex Transm Infect 1998;74:95–100. 10.1136/sti.74.2.95
    1. Peters RP, Nijsten N, Mutsaers J et al. . Screening of oropharynx and anorectum increases prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection in female STD clinic visitors. Sex Transm Dis 2011;38:783–7. 10.1097/OLQ.0b013e31821890e9
    1. Dudareva-Vizule S, Haar K, Sailer A et al. . Prevalence of pharyngeal and rectal Chlamydia trachomatis and Neisseria gonorrhoeae infections among men who have sex with men in Germany. Sex Transm Infect 2014;90:46–51. 10.1136/sextrans-2012-050929
    1. Freeman AH, Bernstein KT, Kohn RP et al. . Evaluation of self-collected versus clinician-collected swabs for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae pharyngeal infection among men who have sex with men. Sex Transm Dis 2011;38:1036–9. 10.1097/OLQ.0b013e318227713e
    1. Bachmann LH, Johnson RE, Cheng H et al. . Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis rectal infections. J Clin Microbiol 2010;48:1827–32. 10.1128/JCM.02398-09
    1. Bachmann LH, Johnson RE, Cheng H et al. . Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae oropharyngeal infections. J Clin Microbiol 2009;47:902–7. 10.1128/JCM.01581-08
    1. Freeman AH, Bernstein Kyle T, Kohn Robert P et al. . Evaluation of self-collected versus clinician-collected swabs for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae pharyngeal infection among men who have sex with men. Sex Transm Dis 2011;38:1036–9. 10.1097/OLQ.0b013e318227713e
    1. Hunte T, Alcaide M, Castro J. Rectal infections with chlamydia and gonorrhoea in women attending a multiethnic sexually transmitted diseases urban clinic. Int J STD AIDS 2010;21:819–22. 10.1258/ijsa.2010.009279
    1. Kent CK, Chaw JK, Wong W et al. . Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis 2005;41:67–74. 10.1086/430704
    1. Schachter J, Philip SS. Testing men who have sex with men for urethral infection with Chlamydia trachomatis and Neisseria gonorrhoeae is only half the job, and we need the right tools. Sex Transm Dis 2011;38:925–7. 10.1097/OLQ.0b013e318230f3d6
    1. Ministerio de Salud, Peru. Norma Técnica de salud para el manejo de infecciones de transmisión sexual en el Perú. Lima, Peru; 2009.
    1. NIMH Collaborative HIV/STD Prevention Trial Group. The feasibility of audio computer-assisted self-interviewing in international settings. AIDS 2007;21(Suppl 2):S49–58.
    1. Chai SJ, Aumakhan B, Barnes M et al. . Internet-based screening for sexually transmitted infections to reach nonclinic populations in the community: risk factors for infection in men. Sex Transm Dis 2010;37:756–63. 10.1097/OLQ.0b013e3181e3d771
    1. Howard EJ, Xu F, Taylor SN et al. . Screening methods for Chlamydia trachomatis and Neisseria gonorrhoeae infections in sexually transmitted infection clinics: what do patients prefer? Sex Transm Infect 2011;87:149–51. 10.1136/sti.2010.045807
    1. Wacholder S. Binomial regression in GLIM: estimating risk ratios and risk differences. Am J Epidemiol 1986;123:174–84.
    1. Deddens JA, Petersen MR. Approaches for estimating prevalence ratios. Occup Environ Med 2008;65:481, 501–6 10.1136/oem.2007.034777
    1. Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003;3:21 10.1186/1471-2288-3-21
    1. Petersen MR, Deddens JA. A comparison of two methods for estimating prevalence ratios. BMC Med Res Methodol 2008;8:9 10.1186/1471-2288-8-9
    1. Victora CG, Huttly SR, Fuchs SC et al. . The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol 1997;26:224–7. 10.1093/ije/26.1.224
    1. Johnson JB, Omland KS. Model selection in ecology and evolution. Trends Ecol Evol (Amst) 2004;19:101–8. 10.1016/j.tree.2003.10.013
    1. Vrieze SI. Model selection and psychological theory: a discussion of the differences between the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). Psychol Methods 2012;17:228–43. 10.1037/a0027127
    1. Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 2007;165:710–18. 10.1093/aje/kwk052
    1. Sanchez J, Lama JR, Kusunoki L et al. . HIV-1, sexually transmitted infections, and sexual behavior trends among men who have sex with men in Lima, Peru. J Acquir Immune Defic Syndr 2007;44:578–85. 10.1097/QAI.0b013e318033ff82
    1. Kapala J, Biers K, Cox M et al. . Aptima Combo 2 testing detected additional cases of Neisseria gonorrhoeae infection in men and women in community settings. J Clin Microbiol 2011;49:1970–1. 10.1128/JCM.02062-10
    1. Prevention, C.f.D.C.a. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae—2014. MMWR Recomm Rep 2014;63(RR-02):1–19.
    1. Olshen E, Shrier L.A. Diagnostic tests for chlamydial and gonorrheal infections. Semin Pediatr Infect Dis 2005;16:192–8. 10.1053/j.spid.2005.04.008
    1. Press N, Chavez VM, Ticona E et al. . Screening for sexually transmitted diseases in human immunodeficiency virus-positive patients in Peru reveals an absence of Chlamydia trachomatis and identifies Trichomonas vaginalis in pharyngeal specimens. Clin Infect Dis 2001;32:808–14. 10.1086/319202
    1. Group, N.C.H.S.P.T. Sexually transmitted disease and HIV prevalence and risk factors in concentrated and generalized HIV epidemic settings. AIDS 2007;21 Suppl 2:S81–90.
    1. Cárcamo CP, Campos PE, García PJ et al. . Prevalences of sexually transmitted infections in young adults and female sex workers in Peru: a national population-based survey. Lancet Infect Dis 2012;12:765–73. 10.1016/S1473-3099(12)70144-5
    1. León SR, Konda KA, Klausner JD et al. . Chlamydia trachomatis infection and associated risk factors in a low-income marginalized urban population in coastal Peru. Rev Panam Salud Publica 2009;26:39–45. 10.1590/S1020-49892009000700006
    1. Renault CA, Israelski DM, Levy V et al. . Time to clearance of Chlamydia trachomatis ribosomal RNA in women treated for chlamydial infection. Sex Health 2011;8:69–73. 10.1071/SH10030
    1. Miranda AE, Szwarcwald CL, Peres RL et al. . Prevalence and risk behaviors for chlamydial infection in a population-based study of female adolescents in Brazil. Sex Transm Dis 2004;31:542–6. 10.1097/01.olq.0000137899.25542.75
    1. Acosta-Cázares B, Ruiz-Maya L, Escobedo de la Peña J. Prevalence and risk factors for Chlamydia trachomatis infection in low-income rural and suburban populations of Mexico. Sex Transm Dis 1996;23:283–8. 10.1097/00007435-199607000-00007
    1. Chow JM, Bauer H.M., Bolan G. Repeating low-positive nucleic acid amplification test results for Chlamydia trachomatis and Neisseria gonorrhoeae: assessment of current practice in selected California public- and private-sector laboratories. J Clin Microbiol 2012;50:539 10.1128/JCM.06225-11
    1. Moncada J, Schachter J, Liska S et al. . Evaluation of self-collected glans and rectal swabs from men who have sex with men for detection of Chlamydia trachomatis and Neisseria gonorrhoeae by use of nucleic acid amplification tests. J Clin Microbiol 2009;47:1657–62. 10.1128/JCM.02269-08

Source: PubMed

3
Abonnieren