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High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among HIV-1 negative men who have sex with men in coastal Kenya
  1. Eduard J Sanders1,2,
  2. Alexander N Thiong'o1,
  3. Haile Selassie Okuku1,
  4. John Mwambi1,
  5. Frances Priddy3,
  6. Juma Shafi4,
  7. Henry de Vries5,6,
  8. R Scott McClelland4,7,
  9. Susan M Graham1,7
  1. 1Centre for Geographic Medicine Research ─ Coast, Kenya Medical Research Institute (KEMRI) ─ Kilifi, Kilifi, Kenya
  2. 2Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Headington, UK
  3. 3International AIDS Vaccine Initiative, New York, USA
  4. 4Department of Medicine, University of Nairobi, Nairobi, Kenya
  5. 5STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
  6. 6Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  7. 7Department of Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Eduard J Sanders, Kenya Medical Research Institute, Centre for Geographic Medicine Research – Coast, PO Box 230, Kilifi, Kenya; esanders{at}


Objectives To assess the burden of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in high-risk HIV-1 negative men who have sex with men (MSM) in Africa.

Methods Before the start of a pre-exposure prophylaxis trial, HIV-1 negative volunteers were screened for sexually transmitted infection (STI) including CT and NG, using a highly sensitive and specific nucleic acid amplification test. Samples positive for CT by Aptima testing, were evaluated for the presence of lymphogranuloma venereum (LGV) serovars using an in-house PCR assay. All men were asked to submit a urine specimen, and all had a rectal swab collected by a clinician. Men were asked if they had dysuria, urethral or rectal discharge, or rectal pain.

Results 43 HIV-1 negative MSM were screened, of whom 13 reported sex with men only; the majority (27/43) reported sex work. One volunteer had dysuria and another, rectal pain. Eleven MSM (26%, 95% CI 14% to 41%) had infections with either or both pathogens. Homosexual men had a higher prevalence of any infection than bisexual men (46% vs 17%, p=0.04), and all cases of rectal infections, including one with CT, two with NG and two with CT/NG co-infection. All patients with CT were negative for LGV. One patient with a rectal NG infection reported rectal pain.

Conclusions A remarkably high burden of STI infection was found among HIV-1 negative MSM. Most (12/13) infections, including three of four rectal NG infections, were subclinical. These findings suggest that high-risk MSM will benefit from effective STI screening in Kenya.

  • MSM
  • RAI
  • rectal STI
  • LGV
  • PrEP screening
  • Africa
  • anogenital
  • anorectal
  • men

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  • Funding International AIDS Vaccine Initiative.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the National Ethical Review Committee of the Kenya Medical Research Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.