Research Article: Prevalence and factors associated with gonorrhea infection with respect to anatomic distributions among men who have sex with men

Date Published: April 3, 2019

Publisher: Public Library of Science

Author(s): Jiratha Budkaew, Bandit Chumworathayi, Chamsai Pientong, Tipaya Ekalaksananan, Joan A. Caylà.


Gonorrhea (GC) infection caused by Neisseria gonorrhoeae has been steadily increasing in Thailand over the last decade. Men who have sex with men (MSM) are at high risk for gonorrhea infection.

In this study, we determined the prevalence of and risk factors associated with gonococcal infections by three anatomical sites among MSM. We have conducted a cross-sectional analysis of a sexually transmitted disease (STD), gonorrhea among MSM attending two STD clinics in Khon Kaen, Thailand. We included 358 MSM over 18 years of age. Data were collected using self-administered questionnaire. In each participant, an oropharyngeal, anorectal, and endourethral swab were tested with culture and nucleic acid amplification test (NAAT). However, 267 urine samples were tested by both methods. Factors associated with gonorrhea infections were assessed using univariate and multivariate logistic regression.

One hundred and ninety-five out of 358 (54.47%) MSM tested were found to be positive for gonorrhea using a porA gene targeted NAAT by Real-time PCR with TaqMan probes, but there was no positive result by culture. The gonorrheal prevalence for male genital site, anal, and oropharyngeal, were 34.73% (95%CI 33.07, 45.08), 29.01% (95%CI 24.61, 34.33), and 27.93% (95%CI 23.35, 32.89), respectively, while 5.9% (21/355) were positive for gonococcal infection in all anatomic sites (oropharynx + anus + urethra) of one participant. Previous history of diagnosed STDs was a significant factor associated urethral gonorrhea (odds ratio = 3.52, 95%CI 1.87–6.66, P Value< 0.001). In addition, having more than one partner was increased urethral gonorrhea (adjusted odds ratio = 2.26, 95%CI 1.10–4.68, P Value = 0.026). 100% of condom use was found decreasing urethral infection (adjusted odds ratio = 0.39, 95%CI 0.15–0.99, P Value = 0.046). The most common anatomic site of gonorrhea infection was male genital site, and the independent risk factors were having history of diagnosed STDs and having more than one partner in the past 3 months, but 100% condom use was a protective factor of this infection.

Partial Text

Gonorrhea (GC) caused by Neisseria Gonorrhoeae is a high prevalent sexually transmitted disease (STD) in less-developed countries and lower [1] and it is still substantial and increasing rates of disease in many developed countries [2]. GC is treatable with administration of appropriate antibiotics albeit problem of antibiotic resistance is rising [3]. Symptoms of gonorrhea are yellowish discharge from penis, burning sensation, dysuria, anal discharge and anal itching, erythematous exudate of pharynx, and sore throat [2]. Asymptomatic gonorrhea is significantly common in men who have sex with men (MSM) which remains undiagnosed and untreated and may lead to a reservoir which can result in widespread transmission among multiple partners [4]. In extra-genital sites, oropharyngeal and rectal infections are mostly asymptomatic and may be important in gonorrheal transmission among MSM [5–6].

We recruited a total of 358 people. No one was screened and found that he is ineligible. The median age was 28 years old (minimum–maximum: 18–60 years) among those who were included in this study and whose data were analyzed (Table 1). Three participants refused to provide anal and urethral swabs. For urethral gonorrhea, we firstly performed urethral swab, after reviewing in more detail, the evidence indicated that urine is one of an appropriated sample for gonorrhea infection. Then, 267 participants collected their urine. More than half (52.79%) had both insertive and receptive anal sexual behavior and were employed (58.10%). Thirty-one percent (31.84%) of participants were diagnosed HIV-positive, while 22.63% had a history of previous STDs. The majority of participants were asymptomatic. They attended two STD clinics for regular check up every 3 months. Three participants (less than 1%) indicated they had a symptom of gonorrhea. Based on clinical symptoms, the reported sites of infection were urethra and anus. One hundred and ninety eight (55.3%) indicated that they did not know of any history of previous STDs among their partners.

This is the first study to report the prevalence of gonorrhea infection at an STD and ARV clinic in Khon Kaen Hospital by molecular testing. Diagnosis of any STDs among persons practicing risky sexual behaviors, and particularly persons infected with HIV has significant public health consequences. If these people and their partners continue their risky behaviors (e.g., inconsistent condom use with all partners), they may increase spreading of STDs and HIV infection [29]. Therefore, routine screening for STDs should be done for early detection and adequate treatment whether they have symptoms or not.

There are a number of limitations to our study, the main limitation being that our samples obtained by a combination method of registration and snowball sampling of MSM who were purposively recruited from two sexual health services frequented by higher risk MSM and the majority of which had history of a HIV seropositive, which may have influenced our results. It is possible therefore that our self-selected sample may be biased and our findings may not be generalizable to the broader community of MSM.

The prevalence of gonorrhea among asymptomatic MSM in this study was very high. The most common site of gonorrhea infection was male genital site, and the independent risk factors for male genital gonorrhea were history of diagnosed STDs and having more than one partner in the past 3 months. On the other hand, 100% condom use was a protective factor of gonorrhea infection in a person. There is needed for increased emphasis on gonorrheal infection screening in all three anatomic sites, among asymptomatic MSM. The NAATs method should be implemented in our setting for higher rate detection of gonorrhea. Health education promoting regular condom use should be continued to prevent risk of gonorrhea infection in populations with risky behavior.




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