Asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infection in men who have sex with men living with HIV

Abstract

Background: South Africa faces overlapping epidemics of HIV and sexually transmitted infections (STIs), particularly among men who have sex with men (MSM). Data on asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in MSM living with HIV are limited. Objectives: To determine the prevalence and incidence of asymptomatic C. trachomatis and N. gonorrhoeae infections among MSM living with HIV. Method: We conducted a pilot randomised controlled trial of the HIV coping and disclosure management intervention among 88 MSM living with HIV in Buffalo City, South Africa. Sexually transmitted infection screening for C. trachomatis and N. gonorrhoeae was performed at baseline and at a 17-week follow-up using nucleic acid amplification testing of urine and rectal swabs. Univariable logistic regression models were used to examine the relationship between conceptually important individual-level variables and any STI at baseline and week 17 of follow-up. Results: Mean age was 30 years in the intervention arm and 33 years in the control arm. At enrolment, most participants had an undetectable HIV viral load (79.1% intervention vs 80.0% control). Syphilis positivity was higher in the intervention arm (9.3% vs 2.3%). Baseline prevalence of STIs was high, including urethral and rectal C. trachomatis and N. gonorrhoeae infections. At week 17, STI prevalence was similar between arms (27.9% intervention vs 28.9% control). Univariable analyses did not identify any factors associated with STI at follow-up in either group. Conclusion: Asymptomatic STIs are highly prevalent and incident among MSM living with HIV in South Africa. Findings highlight the need to strengthen STI prevention, treatment and care services, and to innovative interventions.