Cross-sectional study of asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infections in sexually transmitted disease related clinics in Shenzhen, China.

Shu-Xia Chang,Xiao-Ting Liu,Kang-Kang Chen,Yu-Mao Cai,Nan Xia,Pei-Sheng Xiong,Remco Ph Peters

doi:10.1371/journal.pone.0234261

Abstract

The aims of this study were to investigate the prevalence and proportion of laboratory-confirmed urethral Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections that were asymptomatic among individuals presenting to clinics in Shenzhen and the risk factors related to asymptomatic CT infection. In a cross-sectional study, eligible individuals were invited to participate in the questionnaire, and urine specimens were collected to identify CT and NG infections using a nucleic acid amplification test (NAAT). Considering the differences in the presentation of symptoms between men and women, this study was stratified by gender. Corresponding outcomes were analyzed by Chi-square test and multivariate logistic regression. A total of 2,871 participants were asymptomatic and included in our analyses: 1120 (39.0%) men and 1751 (61.0%) women. The prevalence of asymptomatic NG and CT infections was 0.9% and 6.2% in men, and 0.4% and 7.9% in women, respectively. The proportion of asymptomatic urethral CT among men with urethral CT was 28.3%; for women, it was 34.2%. For asymptomatic men with CT, 3 independent risk factors were identified: (1) men under the age of 30 (aOR, 1.83; 95% CI, 1.11-3.03); (2) being employed in the commercial service work (2.82; 1.36-5.84); and (3) being recruited through the urological department (2.12; 1.19-3.79). For asymptomatic women with urethral CT, age less than 30 years was a risk factor. In conclusion, a substantial prevalence of asymptomatic CT infections was found among men and women presenting to clinics in Shenzhen. The significant correlation between asymptomatic CT infection and these risk factors could help identify high-risk populations and guide screening.

Highlights

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the first and second most common bacterial sexually transmitted infections (STIs), with a global incidence of respectively 127.2 million and 86.9 million in 2016.[1]
We investigate the prevalence and proportion of laboratory-confirmed urethral CT and/or NG infections that were asymptomatic among individuals presenting to clinics in Shenzhen and the risk factors related to asymptomatic CT infection
182 (2.6%) participants were positive for NG and 648 (9.2%) for CT

Summary

Introduction

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the first and second most common bacterial sexually transmitted infections (STIs), with a global incidence of respectively 127.2 million and 86.9 million in 2016.[1]. The prevalence of CT and NG observed in this study was considerably higher than the results in the Chinese Health and Family Life Survey where the overall prevalence of CT and NG infections was 2.6% and 0.08% in women, and 2.1% and 0.02% in men, respectively.[7] Shenzhen may be an appropriate place to study risk factors associated with STIs, and evidence-based interventions to reduce the burden of STIs in Shenzhen may be more cost-effective. Knowledge of the burden and risk factors of asymptomatic STIs may have implications for syndromic management which is the primary care for the detection and treatment of suspected STI infections in resource-limited settings.[8, 9] At present, the effectiveness of syndromic management on reduction of the prevalence of STI infections is not satisfactory.[10,11,12] The reason is because of its poor sensitivity, but more importantly, most STI infections such as CT and NG are asymptomatic

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Conclusion