1496. Anorectal Mycoplasma genitalium is Common among Nigerian MSM and Associated with HIV
Session: Poster Abstract Session: Sexually Transmitted Infections
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • Crowell IDWeek Poster_Final.pdf (6.2 MB)
  • Background: Mycoplasma genitalium (MG) is a cause of non-gonococcal, non-chlamydial urethritis and may cause subclinical infection of the anorectum, thereby potentiating HIV transmission among men who have sex with men (MSM). We describe the prevalence and incidence of MG among Nigerian MSM.

    Methods: Adult MSM were recruited in Lagos, Nigeria, and screened for HIV and bacterial sexually transmitted infections (STIs) every three months for up to 18 months. HIV infection was diagnosed using a parallel algorithm of rapid tests. PCR testing for Neisseria gonorrhoeae and Chlamydia trachomatis was performed on voided urine and rectal swab specimens. Nucleic acid amplification testing for qualitative detection of MG ribosomal RNA was performed on first and last available specimens. Wald and exact 95% confidence intervals (95% CIs) were calculated for prevalence and incidence, respectively, by anatomic site. Chi-squared test was used to compare proportions across groups of interest.

    Results: From 13 May 2014-25 July 2016, 413 MSM were tested for MG with median age 23 (interquartile range 20-26) years and HIV prevalence 67.5% (278/413). Anorectal MG prevalence was 36.8% (150/408, 95% CI 32.1-41.4%) and urogenital prevalence was 12.4% (51/410, 95% CI 9.2-16.0%), including 6.0% (25/413) of participants who were infected at both sites. Among prevalent anorectal MG cases, co-infection with gonorrhea was observed in 25.3% (38/150) and chlamydia in 19.3% (29/150). Among prevalent urogenital MG cases, gonorrhea was observed in 0% and chlamydia was observed in 15.7% (8/51). There was a trend toward more MG among participants with anorectal gonorrhea (46.8% vs. 35.0%, p=0.07). Thirty-one new anorectal infections were observed over 272 person-years (11.4/100PY, 95% CI 7.7-16.2/100PY) and 10 incident urogenital infections over 282 person-years (3.5/100PY, 95% CI 1.7-6.5/100PY). Prevalent or incident MG at any site was more common among HIV-infected participants compared to HIV-uninfected (55.4% vs. 38.8%, p=0.0016).

    Conclusion: MG was highly prevalent among MSM in this study, including over half of HIV-infected participants. MG should be considered among cases of urethritis that fail to respond to conventional therapies, particularly in populations with a high burden of HIV, STIs, and frequent drug exposures that promote emergence of drug-resistant MG.

    Trevor A. Crowell, MD, PhD1,2, John Lawlor, M.S.1,2, Kara Lombardi, M.S.1,2, Rebecca Nowak, PhD3, Justin Hardick, MS4, Sunday Odeyemi, MSc, AIMLS1,5, Afoke Kokogho, MB;BS1,5, Jennifer Malia, MS1, Catherine Stewart, B.S., MLS(ASCP)1,2, Stefan Baral, PhD6, Sylvia Adebajo, MD, PhD7, Manhattan Charurat, PhD3, Julie Ake, MD, MSc1, Sheila Peel, MSPH, PhD, DAC1 and Charlotte Gaydos, DrPH, FIDSA4, (1)U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, (2)Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (3)Institute of Human Virology, University of Maryland, Baltimore, MD, (4)Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, (5)Henry M. Jackson Medical Research International, Abuja, Nigeria, (6)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (7)Population Council Nigeria, Abuja, Nigeria

    Disclosures:

    T. A. Crowell, None

    J. Lawlor, None

    K. Lombardi, None

    R. Nowak, None

    J. Hardick, None

    S. Odeyemi, None

    A. Kokogho, None

    J. Malia, Hologic: Research Contractor , Research support .

    C. Stewart, None

    S. Baral, None

    S. Adebajo, None

    M. Charurat, None

    J. Ake, None

    S. Peel, Hologic: Research Contractor , Research support .

    C. Gaydos, BioFire: Consultant , Consulting fee . Cepheid: Speaker's Bureau , Speaker honorarium . Becton Dickinson: Speaker's Bureau , Speaker honorarium .

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