Prevalence of asymptomatic gonorrhea and chlamydia among men having sex with men (MSM) in India and associated risk factors
A. Gurung1, P. Prabhakar2, P. Narayanan1, S. Mehendale3, A. Risbud3, A. Das1
1Family Health International, Delhi, India, 2Family Health International, Hyderabad, India, 3National AIDS Research Institute, Pune, India
Background: There is limited data on the prevalence of sexually transmitted infections (STIs) among MSM in India. We studied the prevalence of symptomatic and asymptomatic rectal, urethral and pharyngeal gonorrhea and chlamydia among MSM and the risk factors found to be associated with acquiring these infections.
Methods: During 2008-09, 513 MSM were recruited from four clinics at two cities of Mumbai and Hyderabad .A questionnaire was administered, clinical examination performed and laboratory samples collected. All MSM were screened for gonorrhea and chlamydia using Aptima Combo 2 for urine samples and pharyngeal swabs, and Roche PCR for rectal swabs. Risk factors such as commercial sexual activity, sexual networks, health seeking behavior and condom use in the last sexual act were analyzed using multivariate analysis.
Results: The overall prevalence of gonorrhea and/or chlamydia amongst MSM was 16.6% (13.8 % had gonorrhea and 5.1 % chlamydia). Of these 81% were asymptomatic with 89 % of rectal, 71% of pharyngeal and 44% of urethral infections lacking clinical signs or symptoms related to gonorrhea or chlamydia. In multivariate analysis, the association of risk factors was highest amongst MSM who were engaged in commercial sex (P < 01). Other risk factors included concurrent multiple sexual partners (P< .05), low condom use during last sexual act (P>, 05) and poor health seeking behavior (P>.05).
Conclusions: The prevalence of asymptomatic gonorrhea and/or chlamydia is high amongst MSM in India. These findings re-iterate the existing national STI treatment guidelines which recommend presumptive treatment for gonorrhea and chlamydia amongst high-risk MSM especially those who engage in commercial sex, have concurrent partners, and low condom use. Regular clinical examination of all three anatomical sites (ano-rectum, urethra and pharynx) and presumptive/regular treatment remains the cornerstone for control of STIs and HIV among MSM in India.