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Epidemiology
Original research
Incident gonorrhoea and chlamydia among a prospective cohort of men who have sex with men in Kisumu, Kenya
  1. Fredrick Otieno1,
  2. George Ng'ety1,
  3. Duncan Okall1,
  4. Carolyne Aketch1,
  5. Eve Obondi1,
  6. Susan Marie Graham2,
  7. Boaz O Nyunya3,
  8. Gaston Djomand4,
  9. Robert C Bailey5,
  10. Supriya D Mehta5
  1. 1 Nyanza Reproductive Health Society, Kisumu, Kenya
  2. 2 Department of Global Health, University of Washington, Seattle, Washington, USA
  3. 3 Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Kisumu, Kenya
  4. 4 Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  5. 5 Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public health, Chicago, Illinois, USA
  1. Correspondence to Dr Supriya D Mehta, Epidemiology and Biostatistics, University of Illinois Chicago, Chicago, IL 60612, USA; supriyad{at}uic.edu

Abstract

Objective STIs disproportionately affect men who have sex with men (MSM) in sub-Saharan Africa. We identified factors associated with incident Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among MSM in the Anza Mapema cohort study in Kisumu, Kenya.

Methods We enrolled 711 MSM who underwent HIV testing and counselling, medical history and examination, and collection of demographic and behavioural information. They also provided urine and rectal swab specimens for CT and NG testing by qualitative PCR at baseline and at months 6 and 12. Separate multivariable Cox regression models identified factors associated with first incident urethral or rectal infection.

Results Among the 619 men aged 18–54 years included in this analysis, there were 83 first incident urethral CT/NG infections (14.4 cases per 100 person-years (PY)) and 40 first incident rectal infections (6.84 cases per 100 PY), and an overall incidence of 18.0 cases per 100 PY (95% CI 14.8 to 21.8). Most urethral (84%) and rectal (81%) infections were asymptomatic. In the adjusted model, the risk of first incident urethral CT/NG decreased by 4% for each 1-year increase in age and was 41% lower for men who reported their partner used condom at last sexual encounter. Men who were HIV-positive had a 68% less risk of urogenital CT/NG compared with those who were negative. Men who reported being usually receptive or versatile as compared with usually insertive had an 81% increased risk of incident urogenital CT/NG.

Conclusion Our study demonstrated a high incidence of urethral CT/NG infection, with somewhat lower incidence of rectal CT/NG infection, despite repeated testing and treatment, highlighting the need for preventive interventions to decrease the burden of CT/NG among Kenyan MSM. Most infections were asymptomatic, and routine aetiological screening for STIs is recommended.

  • Neisseria gonorrhoeae
  • Chlamydia trachomatis
  • Africa
  • Gay men
  • incidence studies

https://doi.org/10.1136/sextrans-2019-054166

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    Footnotes

    • Handling editor Nicola Low

    • Contributors FO: conceptualised the study design and measures, obtained funding, wrote the first draft of the manuscript, critical review and revision of the manuscript for important intellectual content. GN, CA: implementation of study measures, data acquisition, critical review and revision of the manuscript for important intellectual content. DO: contributed to development and implementation of study measures, data acquisition, critical review and revision of the manuscript for important intellectual content. EO: contributed to development and implementation of study measures, data management and cleaning, critical review and revision of the manuscript for important intellectual content. SMG, RCB: conceptualised the study design and measures, obtained funding, critical review and revision of the manuscript for important intellectual content. BON, GD: contributed to development and implementation of study measures, critical review and revision of the manuscript for important intellectual content. SDM: conceptualised the study design and measures, obtained funding, conducted statistical analyses, critical review and revision of the manuscript for important intellectual content.

    • Funding The Anza Mapema study was supported through funding provided by the Centers for Disease Control and Prevention (U01GH000762) and by Evidence for HIV Prevention in Southern Africa (MM/EHPSA/NRHS/0515008).

    • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agencies. Use of trade names is for identification purposes only and does not constitute endorsement by the US Centers for Disease Control and Prevention or the Department of Health and Human Services.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Anza Mapema study was approved by the Maseno University Ethics Review Committee (MSU/DRPC/MUERC/00104/14), the Institutional Review Board of the University of Illinois at Chicago (2014–0778), and the Human Subjects Division of the University of Washington (48148). The protocol was also reviewed according to the human research protection procedures for the US Centers for Disease Control and Prevention, Atlanta, Georgia, USA, and approved as research. All participants provided written informed consent in one of the three languages of their preference: English, Dholuo or Swahili. At each study visit, participants received a standard transport reimbursement of KES 500 (~US$5).

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

    • Data availability statement Data are available upon reasonable request. De-identified data are available on request for reasonable use from FO (Fotieno@nrhskenya.org) or SDM (Supriyad@uic.edu).