DOI: 10.1097/olq.0000000000002405 ISSN: 0148-5717

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among Ugandan Adolescents and Adults Vulnerable to HIV

Madelaine Ouellette, Natalie Burns, Roger Ying, Immaculate Nakabuye, Grace Mirembe, Ronald Ephraim Wasswa, Justine Nalunga, Emmanuel Wasswa, Prossy Naluyima, Michelle Imbach, Hannah Kibuuka, James Tielsch, Margaret Yacovone, Betty Mwesigwa, Trevor A. Crowell,
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Background:

Chlamydia and gonorrhea are common sexually transmitted infections (STIs) in populations with behavioral vulnerability to HIV. In Uganda, routine syndromic STI management underdiagnoses infections.

Methods:

Between October 2022 and September 2024, we enrolled participants in Kampala, Uganda, aged 14-55 years, without HIV, who reported a recent documented STI, injection drug use, transactional sex, condomless sex, or anal sex with males. Urine and anorectal/oropharyngeal swabs were tested for Chlamydia trachomatis and Neisseria gonorrhoeae (Xpert CT/NG, Cepheid). Multivariable robust Poisson regression with purposeful variable selection estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for factors potentially associated with each STI.

Results:

Among 420 participants with a median age of 21 years (interquartile range 19-24), 241 (57.4%) were female, and 136 (32.4%) were males who have sex with men (MSM). Chlamydia was more prevalent than gonorrhea (21.9% vs. 13.1%, p <0.001). The anorectum was the most common site of infection with 75 chlamydia cases (17.9% [95%CI: 14.5%-21.8%]) and 51 gonorrhea cases (12.1% [9.4%-15.6%]), followed by the urogenital site with 45 chlamydia cases (10.7% [8.1%-14.0%]) and 23 gonorrhea cases (5.5% [3.7%-8.1%]). Urogenital-only screening would have missed 51.1% and 58.2% of chlamydia and gonorrhea cases, respectively, while urogenital+anorectal screening would have missed 1.1% and 0%. Male sex was independently associated with increased prevalence of chlamydia (aPR 2.06 [1.37-3.11], p =0.001) and gonorrhea (PR 2.81 [1.56-5.06], p =0.001). Chlamydia was also more common among participants aged 15-24 years compared to 25-40 (aPR 2.11 [1.02-4.35], p =0.043).

Conclusions:

Ugandan healthcare policies should consider anorectal chlamydia and gonorrhea testing, particularly among youth and MSM, to improve STI detection and reduce transmission.

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