Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA.
Sex Transm Infect. 2022 May;98(3):178-187. doi: 10.1136/sextrans-2020-054753. Epub 2021 May 6.
BACKGROUND: STIs among men who have sex with men (MSM) and transgender women (TGW) continue to increase. In Rwanda, STI management relies on syndromic management with limited empirical data characterising the burden of specific STIs among MSM/TGW. This study evaluated the prevalence of syphilis, (NG) and (CT) and associated factors among MSM/TGW in Kigali. METHODS: From March to August 2018, 737 MSM/TGW >18 years were enrolled using respondent-driven sampling (RDS). Structured interviews and HIV/STI screening were conducted. Syphilis was screened with rapid plasma reagin confirmed by hemagglutination assay. CT/NG were tested by Cepheid GeneXpert. RDS-adjusted multivariable Poisson regression models with robust variance estimation were used to evaluate factors associated with any STI, and determinants of urethral and rectal STIs separately. RESULTS: Prevalence of any STI was 20% (RDS adjusted: 16.7% (95% CI: 13.2% to 20.2%)). Syphilis was 5.7% (RDS adjusted: 6.8% (95% CI: 4.3% to 9.4%)). CT was 9.1% (RDS adjusted: 6.1% (95% CI: 3.9% to 8.4%)) and NG was 8.8% (RDS adjusted: 7.1% (95% CI: 4.9% to 9.2%)). STIs were more common among older MSM and those with HIV (p<0.05). Of CT infections, 67% were urethral, 27% rectal and 6% were dual site. For NG infections, 52% were rectal, 29% urethral and 19% were dual site. Overall, 25.8% (23 of 89) of those with confirmed STI and returned for their results were symptomatic at time of testing.STI symptoms in the previous year (adjusted prevalence ratio (aPR): 1.94 (95% CI: 1.26 to 2.98)) were positively associated with any STI. Being circumcised was negatively associated with any STI (aPR: 0.47 (95% CI: 0.31 to 0.73)). HIV was positively associated with rectal STIs (aPR: 3.50 (95% CI: 1.09 to 11.21)) but negatively associated with urethral STIs. CONCLUSION: MSM/TGW, especially those living with HIV, are at high risk of STIs in Rwanda with the vast majority being asymptomatic. These data suggest the potential utility of active STI surveillance strategies using highly sensitive laboratory methods among those at high risk given the anatomical distribution and limited symptomatology of STIs observed among Rwandan MSM/TGW.
背景：男男性行为者（MSM）和跨性别女性（TGW）中的性传播感染（STI）持续增加。在卢旺达，STI 的管理依赖于综合征管理，缺乏描述 MSM/TGW 中特定 STI 负担的经验数据。本研究评估了基加利 MSM/TGW 中梅毒、（NG）和（CT）的患病率以及相关因素。
方法：2018 年 3 月至 8 月，使用响应驱动抽样（RDS）招募了 737 名年龄在 18 岁以上的 MSM/TGW。进行了结构化访谈和 HIV/STI 筛查。使用快速血浆反应素（RPR）进行梅毒筛查，并用血凝试验确认。使用 Cepheid GeneXpert 检测 CT/NG。使用具有稳健方差估计的 RDS 调整多变量泊松回归模型评估与任何 STI 相关的因素，并分别评估尿道和直肠 STI 的决定因素。
结果：任何 STI 的患病率为 20%（RDS 调整：16.7%（95%CI：13.2%至 20.2%））。梅毒为 5.7%（RDS 调整：6.8%（95%CI：4.3%至 9.4%））。CT 为 9.1%（RDS 调整：6.1%（95%CI：3.9%至 8.4%））和 NG 为 8.8%（RDS 调整：7.1%（95%CI：4.9%至 9.2%））。年龄较大的 MSM 和 HIV 感染者中 STIs 更常见（p<0.05）。CT 感染中，67%为尿道，27%为直肠，6%为双重部位。NG 感染中，52%为直肠，29%为尿道，19%为双重部位。总的来说，25.8%（89 人中的 23 人）在确认 STI 并返回结果时出现症状。过去一年的 STI 症状（调整后患病率比（aPR）：1.94（95%CI：1.26 至 2.98））与任何 STI 呈正相关。包皮环切与任何 STI 呈负相关（aPR：0.47（95%CI：0.31 至 0.73））。HIV 与直肠 STI 呈正相关（aPR：3.50（95%CI：1.09 至 11.21）），但与尿道 STI 呈负相关。
结论：卢旺达 MSM/TGW，尤其是那些感染 HIV 的人，面临着很高的 STI 风险，其中绝大多数为无症状感染。这些数据表明，鉴于在卢旺达 MSM/TGW 中观察到的 STI 的解剖分布和有限的症状学，对于高危人群使用高度敏感的实验室方法进行主动 STI 监测策略具有潜在的应用价值。
Zotero 插件