Asymptomatic gonorrhoea and chlamydial infection in rural Tanzanian men

Abstract

Objective: To measure the prevalence of urethritis due to Neisseria gonorrhoeae and Chlamydia trachomatis in rural Tanzanian men. Design: About 500 men aged 15-54 years were selected from each of 12 rural communities by random cluster sampling; interviewed concerning past or present symptoms of sexually transmitted diseases; and asked to provide a first catch urine specimen, which was tested for pyuria with a leucocyte esterase dipstick test. Subjects with symptoms or with a positive result on testing were examined, and urethral swabs were taken for detection of N gonorrhoeae by gram stain and of C trachomatis by antigen detection immunoassay. Setting: Mwanza region, north western Tanzania. Subjects: 5876 men aged 15-54 years. Main outcome measures: Prevalence of urethral symptoms, observed urethral discharge, pyuria, urethritis (>4 pus cells per high power field on urethral smear), N gonorrhoeae infection (intracellular gram negative diplococci), and C trachomatis infection (IDEIA antigen detection assay). Results: 1618 (28%) subjects reported ever having had a urethral discharge. Current discharge was reported by 149 (2.5%) and observed on examination in 207 (3.5%). Gonorrhoea was found in 128 subjects (2.2%) and chlamydial infection in 39 (0.7%). Only 24 of 158 infected subjects complained of urethral discharge at the time of interview (15%). Conclusion: Infection with N gonorrhoeae and C trachomatis is commonly asymptomatic among men in this rural African population. This has important implications for the design of control programmes for sexually transmitted disease. Key messages After decades of neglect, facilities for their treatment are poorly developed in many countries There is increasing evidence that the treatable bacterial sexually transmitted diseases facilitate the heterosexual transmission of HIV Asymptomatic urethral infection with Neisseria gonorrhoeae and Chlamydia trachomatis is common in rural Tanzanian men In view of the high prevalence of asymptomatic infection in both men and women, the control of sexually transmitted diseases in developing countries will require innovative approaches to screening or mass treatment, or both, in addition to improved clinical services for patients with symptoms