Research Article Link: https://pubmed.ncbi.nlm.nih.gov/41873979/

The Nyanza Reproductive Health Society (NRHS) reports findings from a recent study examining the prevalence and associated factors of sexually transmitted infections (STIs) among men who have sex with men (MSM) in Kenya. The analysis focuses on infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae, with attention to both urethral and rectal sites.

Study Overview

This cross-sectional analysis draws on baseline data from the Mbili Pamoja cohort, conducted between June and November 2024. A total of 501 participants aged 18–39 years were enrolled:

• 250 participants in Kisumu
• 251 participants in Nairobi

Laboratory diagnostics included:

• Urine samples for detection of urethral infections
• Clinician-collected rectal swabs for detection of rectal infections

Multivariable logistic regression was used to identify factors independently associated with infection at each anatomical site.

Prevalence of Infection

NRHS findings indicate a substantial burden of STIs among MSM, with variation across sites and locations:

• Urethral CT and/or NG infections
  • Kisumu: 9.2%
  • Nairobi: 3.7%
• Rectal CT and/or NG infections
  • Kisumu: 10.4%
  • Nairobi: 18.7%

Rectal infections were notably higher in Nairobi, while urethral infections were more prevalent in Kisumu.

Symptom-Based Detection

The study assessed the reliability of self-reported symptoms:

• Dysuria sensitivity: 38.6%
• Penile discharge sensitivity: 30.6%
• Specificity for both: above 80%

Rectal symptoms were infrequently reported, though when present they showed moderate sensitivity and high specificity.

These results indicate that a significant proportion of infections are asymptomatic, limiting the effectiveness of symptom-based approaches to diagnosis and management.

Factors Associated with Urethral Infections

In adjusted analyses, urethral CT/NG infections were more likely among:

• Participants aged 25–29 years (compared to 18–24 years)
• Individuals whose most recent sexual partner was a cisgender woman
• Participants identifying as transgender or non-binary

Hazardous drug use was inversely associated with urethral infections.

Factors Associated with Rectal Infections

Rectal CT/NG infections were associated with:

• Receptive or versatile sexual roles
• Participation in group sex
• Identifying as transgender or non-binary
• Elevated depressive symptoms

Inverse associations were observed with:

• Hazardous alcohol use
• Food insecurity
• Recent antibiotic use

These findings reflect complex interactions between behavioral, biological, and structural factors.

Interpretation

NRHS interprets these findings as evidence of:

• A high and clinically significant prevalence of both urethral and rectal STIs
• A substantial proportion of infections that are not detectable through symptoms
• Distinct epidemiological patterns depending on anatomical site

The association between depressive symptoms and rectal infections highlights the importance of integrating mental health into sexual health programming. Additionally, observed differences across gender identities underscore the need for inclusive and responsive healthcare services.

Public Health Implications

Based on these findings, NRHS emphasizes the following priorities:

• Expansion of routine, site-specific STI screening beyond symptom-based approaches
• Integration of mental health and substance use services within STI prevention and care
• Development of inclusive, non-discriminatory health services responsive to diverse populations
• Context-specific interventions reflecting local epidemiological patterns

Conclusion

NRHS findings demonstrate that MSM in Kisumu and Nairobi experience a substantial burden of urethral and rectal STIs, many of which are asymptomatic. Addressing this burden requires strengthened diagnostic access, integrated service delivery, and public health strategies grounded in the lived realities of affected communities.