Prevalence of and Factors Associated With Urethral and Rectal STIs Among a Cross-Sectional Sample Men Who Have Sex...

We examined the prevalence and factors associated with sexually transmitted infections (STIs) among men who have sex with men (MSM) in Kenya.

A cross-sectional analysis was conducted using baseline data from the Mbili Pamoja cohort study, which enrolled 501 MSM (250 in Kisumu and 251 in Nairobi) aged 18 to 39 y between June and November 2024. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were detected in urine and clinician-collected rectal swabs. Multivariable logistic regression was used to identify factors associated with urethral and rectal CT/NG.

The prevalence of urethral CT and/or NG infections was 9.2% in Kisumu and 3.7% in Nairobi; rectal CT and/or NG prevalence was 10.4% in Kisumu and 18.7% in Nairobi. In multivariable analysis, urethral CT/NG was more common among MSM aged 25 to 29 y versus 18 to 24 y, last sex partner being a cisgender woman, and identifying as transgender or nonbinary. Hazardous drug use was inversely associated with urethral STIs. Rectal STIs were increased for participants reporting receptive or versatile sexual role, group sex, being transgender/nonbinary, and elevated depressive symptoms. Hazardous alcohol use, food insecurity, and recent antibiotic use were inversely associated with rectal infections. Self-reported dysuria and penile discharge showed low sensitivity (38.6% and 30.6%, respectively) and high specificity (>80%) for urethral infections. Rectal symptoms were infrequently reported but showed moderate sensitivity and high specificity.

MSM in Kisumu and Nairobi have a substantial burden of frequently asymptomatic urethral and rectal CT and NG infections. While some modifiable sexual exposures were identified, results also highlight the need for integrated mental health and substance use services.