Validity of Chlamydia, Gonorrhea, and Syphilis Management in Men who have Sex with Men of Kisumu, Kenya

Background: Despite having high incidence and prevalence of STIs, the identification and treatment of infection in men who have sex with men (MSM) is difficult in certain areas of the world. Conservative sexual values, criminal punishment for sex workers, and difficulty of engaging MSM in homophobic societies inhibit individuals from seeking treatment or accurately reporting risky behavior. In settings without laboratories, diagnosis is made clinically based on the presence of symptoms, known as syndromic management. If the STI epidemic is going to be curbed, improvement of STI surveillance and monitoring is needed due to problems with access, utilization, and sensitivity of STI reporting. Aim 1: to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of syndromic management of chlamydia, gonorrhea, and syphilis in gay and bisexual MSM (GBMSM) participating in the Anza Mapema study in Kisumu, Kenya. Aim 2: to estimate the time between specimen collection and treatment of MSM with laboratory and clinically diagnosed sexually transmitted infections at Anza Mapema in Kisumu, Kenya. Aim 3: to estimate the rate of men who test positive for a curable sexually transmitted infection, but never receive treatment. The rate will be described as failure-to-treat. Methods: This study is nested within a parent cohort study called Anza Mapema which took place between 2015 and 2017. The sensitivity, specificity, PPV, and NPV were calculated for syndromic treatment. Time-to-treat was calculated as median time in days. Failure-to-treat rates were estimated as a percentage. Results: The sensitivity of syndromic management at Anza Mapema was estimated to be 8.4% (4.8, 13.5), specificity was 99.3% (98.8, 99.7), PPV was 57.7% (36.9, 76.7) and NPV was 90.7% (89.3, 92.1). Median time-to-treat for syndromic treatment was 0 days (IQR of 0-0) and for laboratory treatment was 130 days (IQR of 92-173). For laboratory and syndromic diagnoses STIs, failure-to-treat rates were 70.3% and 3.1%. Conclusions: In resource limited settings, syndromic diagnosis is a more effective method for treating STIs than laboratory diagnosis. The process from specimen collection to proper treatment of the infection can possibly lead to a high failure-to-treat rate. Without properly run systems for management where nearly 100% of diagnosed individuals receive proper treatment, laboratory diagnosis may not be very beneficial to treatment.