Predictive values of WHO's presumptive treatment algorithm and alternative criteria for treatment of asymptomatic rectal infections in MSM, Coastal Kenya, 2011–2012
| MSM (N=147) reporting RAI and meeting risk criteria in past 6 months | MSM with any rectal infection (N=27), N (%) | MSM without rectal infection (N=120), N (%) | Sensitivity, % (95% CI) | Specificity, % (95% CI) | PPV, % (95% CI) | NPV, % (95% CI) | AUC |
|---|---|---|---|---|---|---|---|
| WHO risk criteria* (N=85) | 20 (23.5)† | 65 (76.5) | 74.1 (53.7 to 88.9) | 45.8 (36.7 to 55.2) | 23.5 (15.0 to 34.0) | 88.7 (78.1 to 95.3) | 0.60 |
| Did not meet WHO risk criteria (N=62) | 7 (11.3)‡ | 55 (88.7) | |||||
| Multiple partners (N=123) | 25 | 98 | 92.6 (75.7 to 99.1) | 18.3 (11.9 to 26.4) | 20.3 (13.6 to 28.5) | 91.7 (73.0 to 99.0) | 0.56 |
| No multiple partners (N=24) | 2 | 22 | |||||
| Unprotected RAI (N=96) | 22 | 74 | 81.5 (62.0 to 93.7) | 38.3 (29.6 to 47.7) | 22.9 (15.0 to 32.6) | 90.2 ( 78.6 to 96.7) | 0.60 |
| No unprotected RAI (N=51) | 5 | 46 | |||||
| Partner with STI (N=10) | 1 | 9 | 3.7 (0.1 to 19.0) | 92.5 (86.2 to 96.5) | 10.0 (0.3 to 44.5) | 81.0 ( 73.4 to 87.2) | 0.52 |
| No partner with STI (N=137) | 26 | 111 | |||||
| Multiple partners or partner with STI (N=125) | 25 | 100 | 92.6 (75.7 to 99.1) | 16.7 (10.5 to 24.6) | 20.0 (13.4 to 28.1) | 90.9 ( 70.8 to 98.9) | 0.55 |
| No multiple partners and no partner with STI (N=22) | 2 | 20 | |||||
| Multiple partners or unprotected RAI (N=136) | 27 | 109 | 100.0 (87.2 to 100.0) | 9.2 (4.7 to 15.8) | 19.9 (13.5 to 27.6) | 100.0 (71.5 to 100.0) | 0.50 |
| No multiple partners and no unprotected RAI (N=11) | 0 | 11 | |||||
| Unprotected RAI or partner with STI (N=100) | 23 | 77 | 85.2 (66.3 to 95.8) | 35.8 (27.3 to 45.1) | 23.0 (15.2 to 32.3) | 91.5 ( 79.6 to 97.6) | 0.61 |
| No unprotected RAI and no partner with STI (N=47) | 4 | 43 |
*WHO risk criteria for presumptive treatment of rectal infections (ie, unprotected RAI and either multiple partners or a partner with an STI in the past 6 months).
†Including six NG, 12 CT and two NG–CT co-infections of the rectum.
‡Including two NG, four CT and one NG–CT co-infection of the rectum.
AUC, area under receiver operating characteristic curve; MSM, men who have sex with men; NPV, negative predictive value; PPV, positive predictive value; RAI, receptive anal intercourse; STI, sexually transmitted infection.