College of Medicine, University of Tennessee Health Science Center, Memphis, TN.
South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Sex Transm Dis. 2018 Sep;45(9):607-614. doi: 10.1097/OLQ.0000000000000816.
Gonorrhea (Neisseria gonorrhoeae [GC]) and chlamydia (Chlamydia trachomatis [CT]) disproportionately affect men who have sex with men (MSM), and public health implications vary by anatomic site and bacterial agent. Urethral and rectal GC and CT can increase risk of HIV transmission, whereas pharyngeal GC may be a reservoir for antimicrobial resistance. To define screening priorities in Latin America, we compare differences in the prevalence and correlates of urethral, pharyngeal, and rectal GC and CT among MSM in Peru.
A cross-sectional sample of 787 MSM from Lima was screened between 2012 and 2014. We described prevalence of urethral, pharyngeal, and rectal GC and CT infection and conducted bivariate analyses of associations with social, behavioral, and biological characteristics. Poisson regression analyses assessed the correlates of each infection at each anatomic site.
The most commonly symptomatic infection (urethral GC; 42.1%) was the least prevalent (2.4%). The most prevalent infections were rectal CT (15.8%) and pharyngeal GC (9.9%). Rectal CT was the least commonly symptomatic (2.4%) infection, and was associated with younger age (adjusted prevalence ratio [95% confidence interval], 0.96 [0.94-0.98]), HIV infection (1.46 [1.06-2.02]), and pasivo (receptive; 3.59 [1.62-7.95]) and moderno (versatile; 2.63 [1.23-5.60]) sexual roles.
Results highlight limitations of current syndromic screening strategies for sexually transmitted diseases in Peru, wherein urethral CT and rectal GC and CT may be missed due to their frequently asymptomatic presentations. Successful management of GC and CT infections among MSM in low-resource settings requires differentiating between bacterial agent, symptomatic presentation, associated risk factors, and public health implications of untreated infection at different anatomic sites.
淋病（淋病奈瑟菌[GC]）和衣原体（沙眼衣原体[CT]）在男男性行为者（MSM）中不成比例地发生，并且不同解剖部位和细菌病原体的公共卫生影响也不同。尿道和直肠 GC 和 CT 会增加 HIV 传播的风险，而咽 GC 可能是抗菌药物耐药性的储存库。为了在拉丁美洲确定筛查重点，我们比较了秘鲁 MSM 中尿道、咽和直肠 GC 和 CT 的流行率和相关因素的差异。
2012 年至 2014 年期间，对利马的 787 名 MSM 进行了横断面抽样筛查。我们描述了尿道、咽和直肠 GC 和 CT 感染的流行率，并对与社会、行为和生物学特征相关的关联进行了双变量分析。泊松回归分析评估了每个解剖部位每种感染的相关性。
最常见的症状性感染（尿道 GC；42.1%）的流行率最低（2.4%）。最常见的感染是直肠 CT（15.8%）和咽 GC（9.9%）。直肠 CT 是最不常见的症状性（2.4%）感染，与年龄较小（调整后的流行率比[95%置信区间]，0.96[0.94-0.98]）、HIV 感染（1.46[1.06-2.02]）以及被动（接受）（3.59[1.62-7.95]）和现代（通用）（2.63[1.23-5.60]）性角色有关。
结果突出了秘鲁当前性传播疾病综合征筛查策略的局限性，其中由于无症状表现，可能会错过尿道 CT 和直肠 GC 和 CT。在资源匮乏的环境中，成功管理 MSM 中的 GC 和 CT 感染需要区分不同解剖部位的细菌病原体、症状表现、相关危险因素以及未经治疗感染的公共卫生影响。
