Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infection in men attending STD clinics in Brazil Prevalência de Neisseria gonorrhoeae e infecção pela Chlamydia trachomatis em homens atendidos em clínicas de DST no Brasil

Introduction: The study aimed to assess the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections and identify demographic, behavioral and clinical factors correlated with such infections in men attending six sexually transmitted disease clinics in Brazil. Methods: Multicentric, cross-sectional study performed among men attending STD clinics in Brazil. The study included STD clinics in six cities distributed throughout the five geographic regions of Brazil in 2005. Patients provided 20 ml of first catch urine for testing for NG and CT by DNA-PCR. Results: A total of 767 (92.9%) men were included in the study. The mean age was 26.5 (SD 8.3) years-old. Prevalence of Chlamydia infection was 13.1% (95%CI 10.7%-15.5%) and gonorrhea was 18.4% (95%CI 15.7%21.1%). Coinfection prevalence was 4.4% (95%CI 2.95%-5.85%) in men who sought attendance in STI clinics. Factors identified as associated with C. trachomatis were younger age (15-24) [OR=1.4 (95%CI 1.01-1.91)], present urethral discharge [OR=4.8 (95%CI 1.52-15.05)], genital warts [OR=3.0 (95%CI 1.49-5.92)] and previous history of urethral discharge [OR=2.4 (95%CI 1.11-5.18)]. Variables associated with gonorrhea were younger age (15 to 24) [OR=1.5 (95%CI 1.09-2.05)], presence of urethral discharge [OR=9.9 (95%CI 5.53-17.79)], genital warts [OR=18.3 (95%CI 8.03-41.60)] and ulcer present upon clinical examination [OR=4.9 (95%CI 1.06-22.73)]. Conclusions: These findings have important implications for education and prevention actions directed toward men at risk of HIV/STD. A venue-based approach to offer routine screening for young men in STD clinics should be stimulated. Key-words: Chlamydia trachomatis. Neisseria gonorrhoeae. Risk factors. Multicentric study. STD clinic. PCR. RESUMO Introdução: Nosso objetivo foi acessar a prevalência de Neisseria gonorrhoeae e Chlamydia trachomatis e identificar fatores demográficos, comportamentais e clínicos correlacionados a essas infecções em homens atendidos em clínicas de doenças sexualmente transmissíveis no Brasil. Métodos: Estudo multicêntrico, transversal conduzido em homens que procuraram atendimento em clínicas de DST. O estudo incluiu clínicas de DST em seis cidades distribuídas nas cinco regiões geográficas do Brasil em 2005. Pacientes coletaram 20ml do primeiro jato de urina para testar NG e CT por DNA-PCR. Resultados: Um total de 767 (92,9%) homens foi incluído no estudo. A média de idade foi 26,5 (DP 8,3) anos. A prevalência de infecção por CT foi 13,1% (IC95% 10,7%-15,5%) e NG de 18,4% (IC95% 15,7%-21,1%). A prevalência de co-infecção foi 4,4% (IC95% 2,95%-5,85%). Os fatores identificados como sendo associados com a infecção pela CT foram ser jovem (15-24) [OR=1,4 (IC95% 1,01-1,91)], apresentar corrimento uretral ao exame [OR=4.8 (IC95% 1,52-15,05)], verrugas genitais [OR=3,0 (IC95% 1,49-5,92)] e história prévia de corrimento uretral [OR=2,4 (IC95% 1,11-5,18)]. As variáveis associadas com a gonorréia foram ser jovem (15 to 24) [OR=1,5 (IC95% 1,09-2,05)], apresentar corrimento uretral [OR=9,9 (IC95% 5,53-17,79)], verrugas genitais [OR=18,3 (IC95% 8,03-41,60)] e úlcera ao exame clínico [OR=4,9 (IC95% 1,06-22,73)]. Conclusões: Estes resultados têm implicações importantes para medidas de educação e prevenção direcionadas aos homens com risco acrescido de HIV/DST. A abordagem no serviço para oferecer testes de rotina para homens jovens atendidos em clínica de DST deve ser estimulada. Palavras-chaves: Chlamydia trachomatis. Neisseria gonorrhoeae. Fatores de risco. Estudo multicêntrico. Clínicas DST. PCR. The importance of understanding and addressing Chlamydia trachomatis (CT)infections and gonorrhea among men is being recognized in several studies1,2. The role of identifying and treating male infections in preventing adverse outcomes among women has prompted some researchers to call for Chlamydia trachomatis and gonorrhea screening guidelines directed at detecting male infections3,4. Untreated infections may have direct adverse outcomes among men, including epididymitis, prostatitis and proctitis4,5. Currently, males are opportunistically tested for C. trachomatis infection and/or gonorrhea; recommendations for routinely screening males for these infections are discouraged1. Although several existing studies have examined Chlamydia and gonorrhea infections in men, these studies are geographically limited, targeted to a certain portion of the population6-9. Sexually transmitted disease (STD) Treatment Guidelines of the Centers for Disease Control and Prevention (CDC) recommend empirical treatment for C. trachomatis when treating a diagnosed gonococcal infection, because Chlamydia coinfection is frequent among individuals diagnosed with gonorrhea4. Frequently, coinfection data are derived from STI clinic settings, where patients are likely to present with symptoms of, or suspected exposure to, an STD10. National published data regarding C. trachomatis infections and gonorrhea among men in Brazil is not available, while prevalence date for these infections are available only in local studies11,12. In this study, the prevalence of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis infection and the coinfection rate were assessed and correlated demographic, behavioral and clinical factors were identified in an at-risk population during a multicentric study among men attending STD clinics in six cities in Brazil distributed among the five geographical regions. The information will be used for planning prevention and assistance programs to reach this population.