Prevalence of asymptomatic urethritis by Chlamydia trachomatis and Neisseria gonorrhoeae and associated risk factors among males living with HIV-1

Abstract

Objectives The increase in HIV transmissibility in non-ulcerative sexually transmitted infection is already well-established. It is estimated that symptomatic carriers of N. gonorrhoeae and C. trachomatis have a relative risk of 4.8-fold and 3.6-fold, respectively, for the sexual acquisition of HIV. This type of evaluation for asymptomatic urethritis is necessary to reinforce strategies to combat HIV transmission. This study aims to assess the prevalence of patients with asymptomatic urethritis among men diagnosed with HIV-1 and determine the risk factors associated with this infection.Methods We enrolled a total of 115 male patients aged 18 years or older who have been diagnosed with HIV infection and have no symptoms of urethritis or other sexually transmitted infections and who have been evaluated between May and August 2015 in a follow-up visit at the Immunology Outpatient Clinic of a Brazilian University Hospital.Results Four asymptomatic patients were positive for C. trachomatis and were considered asymptomatic carriers of urethritis. Prevalence was 3.47%. Patients who were positive for C. trachomatis urethritis had a lower mean age (p = 0.015).Conclusion The presence of asymptomatic sexually transmitted infection is a challenge in clinical practice. We recommend that, in outpatient practice, the habit of inquiring on previous sexual behavior to obtain more information about risks and associations with asymptomatic sexually transmitted infection, a routine physical examination and complementary tests to detect STI pathogens should be performed to discard these conditions. The development of rapid tests for this purpose should also be encouraged.

The Direct Semi-Quantitative Detection of 18 Pathogens and Simultaneous Screening for Nine Resistance Genes in Clinical Urine Samples by a High-Throughput Multiplex Genetic Detection System

“…The most significant consequences of CT, UU and MH infections in females include the risk of infertility, ectopic pregnancy, and pelvic inflammatory diseases (Liu et al, 2019). According to previous reports, it is estimated that symptomatic carriers of NG and CT have a relative risk of 4.8-fold and 3.6fold, respectively, for the sexual acquisition of HIV (Silva et al, 2018). Until recently, the diagnosis of CT infections depended on cell culture techniques as the gold standard for the detection of pathogens in clinical specimens (El-Sayed et al, 2006).…”

Chlamydia trachomatis asymptomatic urethritis recurrence among males living with HIV-1

“…In this prospective study, a total of 115 male patients were enrolled, including only those who were diagnosed with HIV infection and had no symptoms of urethritis or other STIs, aged 18 years or older, visiting the Immunology Outpatient Clinic of the Gaffree and Guinle University Hospital between May and August 2015. In the previous study in 2015 1 , we selected 111 patients (111/115) negative for asymptomatic urethritis and four patients (4/115) with asymptomatic urethritis due to C. trachomatis (prevalence = 3.47%) who were treated together with their respective partners, and all of the subjects tested negative for urethritis one week later. We tested the 115 patients again three years later (February and March of 2018), searching for new prevalence data, recurrence or new cases of asymptomatic urethritis.…”

“…A prevalence of 3.47% has been previously reported for asymptomatic urethritis among males living with HIV infection, treated in a large reference center for HIV infection in Brazil. All cases were caused by Chlamydia trachomatis 1 . These data were compared with studies in the general population without HIV infection, which report a prevalence of asymptomatic urethritis of 5% in military Brazilian men and also with other similar studies in the United States that presented prevalences of 1.5%, 3.7% and 5.7% 2 – 5 .…”

“…Studies on asymptomatic urethritis specifically in male populations living with HIV are scarce, but the prevalences reported were 3.8%,6% and 8%, all infections with Chlamydia trachomatis involvement 6 – 8 . C. trachomatis infection is the most prevalent sexually transmitted infection (STI) worldwide 1 . Considering that a large percentage of C. trachomatis infections are asymptomatic, many countries have established public health strategies for infection screening and control 9 , 10 .…”