No abstract

Objectives: Few data are available on the prevalence of sexually transmitted diseases (STDs) in men who have sex with men (MSM), making it difficult to develop STD screening guidelines for this population. The objective of the study was to determine the prevalence of urethral infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae within a large, community based population of MSM, and to assess the feasibility of rectal screening in this population. Methods: This was a cross sectional study of 566 MSM, who were predominantly middle aged, white, asymptomatic, and engaged in sex with multiple partners. All provided a urine sample to screen for chlamydial and gonorrhoea infections using a PCR assay; rectal screening was performed on 48 participants.Results: Urethral C trachomatis infections were detected in 1/566 participants (prevalence 0.2%, 95% CI 0.004% to 1.0%), and rectal C trachomatis infections were detected in 2/48 men (prevalence 4.2%, 95% CI 0.5% to 14.2%). No gonorrhoea infections were detected, and none of the 117 HIV positive men had either infection. Conclusions: Chlamydial and gonorrhoea infections were uncommon in this sample of MSM, even among those with multiple sexual partners or HIV infection. These data call into question recommendations to screen all MSM based on their individual sexual behaviours or HIV. Additional data are needed on the prevalence of these infections in MSM from different settings.M any men who have sex with men (MSM) continue to practise risky sexual behaviours, despite the ongoing risk of HIV infection. 1 2 These behaviours may lead to sexually transmitted infections resulting from Chlamydia trachomatis or Neisseria gonorrhoeae, which continue to be common among some populations of MSM. [1][2][3][4][5][6][7][8][9][10][11] If not detected and treated, these infections may result in painful clinical syndromes such as urethritis, epididymitis, or proctitis, 12 and they also appear to increase the risk of HIV transmission. [13][14][15][16] Because chlamydial and gonorrhoea infections are often asymptomatic, it has been suggested that routine screening for these infections should be performed among at-risk MSM in order to prevent disease complications and to reduce the risk of HIV transmission. 16 17 To date, nearly all data on the prevalence of chlamydial and gonorrhoea infections among MSM have come from men attending sexually transmitted disease (STD) clinics, which may not be representative of other MSM in the community. The most recent recommendations from the US Preventive Services Task Force conclude that there is insufficient information available to recommend for or against screening for chlamydial or gonorrhoea infections among MSM. 18 Until better data are available, the US Centers for Disease Control and Prevention recommends annual STD screening for at-risk MSM, defined as those who are young, who have more than one sex partner per year, or who have HIV infection. 17 Data from MSM outside of STD clinics are urgently needed to confirm current recomme...

This study sought to determine factors associated with chlamydial infection in a low-prevalence college health setting and to determine the testing characteristics of a polymerase chain reaction (PCR) assay for chlamydial infection (AMPLICOR chlamydia test; Roche Diagnostic Systems, Indianapolis) in this population. Young women (n = 1,149) at a university student health clinic underwent testing for cervical chlamydial infection by PCR assay and culture; the characteristics of women with and without chlamydial infection were compared. Chlamydial infection was diagnosed for 26 students (2.3%). The sensitivity and specificity of PCR assay and culture were 85% and 100% and 54% and 100%, respectively. Students with chlamydial infection were more likely to be 20 years of age or younger, have symptoms, report prior chlamydial infection or gonorrhea, report exposure to a sexually transmitted disease (STD), be black, or have cervical signs during examination; however, none of these were significant predictors for asymptomatic women. PCR assay detected significantly more cervical infections than did culture in this college student population. These data are consistent with recommendations for testing college women with symptoms, STD exposure, or age of younger than 25 years.

The lack of IgM antibodies in our case patients demonstrates that they had suffered repeated mycoplasmal infections, which has been frequently observed in adults. Such infections show a more pronounced clinical symptomatic response and a higher inflammatory response than in primary events. As Narita et al. did in their investigations [2], we detected the DNA of M. pneumoniae in our case patients, but no viable mycoplasmal cells. Therefore, one can surmise that CNS infections are not caused by the microorganisms themselves but by an immense immune reaction or an autoimmune response evoked by very high levels of antibodies to M. pneumoniae.Repeated infections with M. pneumoniae can produce interferon, TNF-a, and interleukins, which may be associated with an inflammatory infection. This theory is favored by the fact that M. pneumoniae can trigger the production of cytokines in blood cells and in rat astrocytes [3]. Another possibility is an autoimmune reaction. This is suggested by the fact that M. pneumoniae is able to stimulate an immense B-cell activation, followed by an immense induction of cytokines and autoantibodies, which may lead to the CNS-infection symptoms [4].Altogether, the pathogenesis of CNS infections with M. pneumoniae is still unclear and needs further study. ReplySIR-We agree with Baxter that screening for Chlamydia trachomatis infection in a population among whom the prevalence is low may result in a greater proportion of tests with falsepositive results. However, we do not agree that a specificity of 99% is "pretty good." In fact, the specificity of DNA amplification tests such as PCR analysis is likely to be much higher, approaching 100%. If the test specificity for our sample was indeed "only" 99%, then nearly one-half of the 22 infections diagnosed in our sample would have been expected to be falsepositive results [1]. In fact, all of the 22 infections diagnosed by PCR assay in our study were confirmed by an alternate at university of winnipeg on August 11, 2015