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Body Parts Matter: Social, Behavioral, and Biological Considerations for Urethral, Pharyngeal, and Rectal Gonorrhea and Chlamydia Screening Among MSM in Lima, Peru

Passaro, Ryan Colby, MPH*†; Segura, Eddy R., MD, MPH†‡; Perez-Brumer, Amaya, MSc§; Cabeza, Jeanne, MD, MPH; Montano, Silvia M., MD, MPH; Lake, Jordan E., MD, MSc†∥; Sanchez, Jorge, MD, MPH**††‡‡; Lama, Javier R., MD, MPH**‡‡; Clark, Jesse L., MD, MSc

doi: 10.1097/OLQ.0000000000000816
Original Studies

Background 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.

Methods 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.

Results 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.

Conclusions 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.

High prevalence of asymptomatic rectal chlamydia and pharyngeal gonorrhea among men who have sex with men in Lima, Peru; rectal chlamydia was most common and associated with younger age, HIV infection, receptive sexual role.

From the *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;

Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru;

§Columbia University Mailman School of Public Health, New York, NY;

US Naval Medical Research Unit-6, Callao, Peru;

Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UTHealth, Houston, TX;

**Asociación Civil Impacta Salud y Educación;

††Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, Lima, Peru; and

‡‡Department of Global Health, University of Washington, Seattle, WA

Acknowledgments: The authors thank the study participants and staff who devoted their time and efforts to make this project possible.

Conflicts of Interest and Sources of Funding: Funding for this work was provided by the US National Institute of Health grants NIH R25 MH087222 to J.L.C., R21 MH 092322, and K23 AI110532 to J.E.L. The authors have no conflicts of interest to disclose.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.

Copyright statement: S.M. is an employee of the US Government. This work was prepared as part of her official duties. Title 17 U.S.C. § 105 provides that “Copyright protection under this title is not available for any work of the Unites States Government.” Title 17 U.S.C. § 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person's official duties.

Correspondence: Ryan Colby Passaro, MPH, UCLA SAPHIR Program c/o UCLA Department of Medicine, Division of Infectious Diseases, 10833 Leconte Ave, CHS 37-121, Los Angeles, CA 90095. E-mail:

Received for publication November 28, 2017, and accepted February 6, 2018.

© Copyright 2018 American Sexually Transmitted Diseases Association