Asymptomatic gonorrhoea and chlamydial infection in rural Tanzanian men

BMJ 1996;312:277-280 (3 February)

Papers

Asymptomatic gonorrhoea and chlamydial infection in rural Tanzanian men

H Grosskurth, research fellow,^a P Mayaud, clinical lecturer,^b F Mosha, epidemiologist,^a J Todd, research fellow,^b K Senkoro, statistician,^a J Newell, research fellow,^b R Gabone, director,^a J Changalucha, microbiologist,^a B West, research fellow,^b R Hayes, reader in epidemiology,^b D Mabey, professor of communicable diseases ^b

^a National Institute for Medical Research, PO Box 1482, Mwanza, Tanzania, ^b London School of Hygiene and Tropical Medicine, London WC1E 7HT

Correspondence to: Professor Mabey.

Abstract

Objective: To measure the prevalence of urethritis due to Neisseriagonorrhoeae and Chlamydia trachomatis in rural Tanzanian men.
Design: About 500 men aged 15-54 years were selected from eachof 12 rural communities by random cluster sampling; interviewedconcerning past or present symptoms of sexually transmitteddiseases; and asked to provide a first catch urine specimen,which was tested for pyuria with a leucocyte esterase dipsticktest. Subjects with symptoms or with a positive result on testingwere examined, and urethral swabs were taken for detection ofN gonorrhoeae by gram stain and of C trachomatis by antigendetection immunoassay.
Setting: Mwanza region, north western Tanzania.
Subjects: 5876 men aged 15-54 years.
Main outcome measures: Prevalence of urethral symptoms, observedurethral discharge, pyuria, urethritis (>4 pus cells perhigh power field on urethral smear), N gonorrhoeae infection(intracellular gram negative diplococci), and C trachomatisinfection (IDEIA antigen detection assay).
Results: 1618 (28%) subjects reported ever having had a urethraldischarge. Current discharge was reported by 149 (2.5%) andobserved on examination in 207 (3.5%). Gonorrhoea was foundin 128 subjects (2.2%) and chlamydial infection in 39 (0.7%).Only 24 of 158 infected subjects complained of urethral dischargeat the time of interview (15%).
Conclusion: Infection with N gonorrhoeae and C trachomatis iscommonly asymptomatic among men in this rural African population.This has important implications for the design of control programmesfor sexually transmitted disease.

Key messages

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

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Relevant Article

Chlamydial infection is asymptomatic in England as well as Tanzania: Debashis Mandal and Vivienne Gillanders
BMJ 1996 312: 1231. [Extract] [Full Text]

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