Abstract
BackgroundOur study aimed to describe the concordance of chlamydia infections of the rectum and urethra in men who have sex with men (MSM) and their male partners.MethodsThis was a cross-sectional study of chlamydia in MSM and their male sexual partners both attending Melbourne Sexual Health Centre (MSHC), Australia, between February 2011 and March 2015. We excluded partnerships where testing for chlamydia at both the rectum and urethra were not undertaken.ResultsOur study included 473 partnerships (946 men). 30 men had urethral chlamydia, of whom 14 (47%, 95% CI 28 to 66) had a partner with rectal chlamydia. 46 men had rectal chlamydia, of whom 14 (30%, 95% CI 18 to 46) had a partner with urethral chlamydia. The proportion of men with rectal chlamydia when their partner had urethral chlamydia was significantly higher than the proportion of men with urethral chlamydia when their partner had rectal chlamydia (McNemar’s p = 0.02).ConclusionsThis is the first study of chlamydia concordance in male sexual partnerships and suggests that transmission of chlamydia between the urethra and rectum may be less efficient than has been reported for transmission between the urethra and cervix in heterosexual couples. It also suggests that transmission from the urethra to the rectum may be more efficient than in the opposite direction.
Highlights
Our study aimed to describe the concordance of chlamydia infections of the rectum and urethra in men who have sex with men (MSM) and their male partners
Our data showed that 47% of partners of men with urethral chlamydia had rectal chlamydia while only 30% of partners of men with rectal chlamydia had urethral chlamydia. This difference remained significant when the analysis was restricted by symptoms and condom use. While this cross-sectional study cannot determine the direction of chlamydia transmission within each partnership, the results suggest that transmission from the urethra to the rectum may be more likely than transmission from the rectum to the urethra
We are not able to identify these partnerships, and their exclusion may have introduced a selection bias. These data provide an estimate of the relative probability of transmission of chlamydia between the urethra and rectum, which will assist in the development of mathematical models
Summary
Our study aimed to describe the concordance of chlamydia infections of the rectum and urethra in men who have sex with men (MSM) and their male partners. To address the rising rates of chlamydia, health departments have sought strategies to control this infection. These strategies include screening programmes, and such programmes have been evaluated in heterosexuals, but the most recent and largest clinical trial did not show a significant effect of screening on the prevalence of infection, even when annual screening rates reached 30% [8]. In MSM this information would include the natural duration of infection of the urethra and rectum, the transmission probability between these sites, and the potential role of chlamydia of the pharynx
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