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Prevalence, Duration, and Severity of Rectal Symptoms Among Men Who Have Sex With Men With Rectal Sexually
Shengruo Zhang1, Lindley A Barbee2,3, Olusegun O Soge2,4,5
1Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Background:
Rectal sexually transmitted infections (STIs) are commonly diagnosed among men who have sex with men (MSM), but limited prospective data exist on the rectal symptomatology associated with these infections.
Method:
In 2016-2018, we enrolled 140 MSM in a 48-week cohort study in Seattle, Washington. Participants self-collected weekly rectal specimens that were tested at the end of the study for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and Mycoplasma genitalium (MG) using nucleic acid amplification tests. Participants reported rectal symptoms (rectal discharge, pain, itching, blood in stool, and pain on defecation) in a weekly survey. We calculated the adjusted relative risk (aRR) of the association between incident rectal STIs and rectal symptoms.
Results:
Participants reported rectal symptoms during 12 (38%) of 32 incident rectal CT infections, 6 (30%) of 20 incident rectal GC infections, and 9 (60%) of 15 incident rectal MG infections. Rectal symptoms were significantly more likely to be reported during weeks when participants tested positive for CT, GC, or MG (8.1% [44/544]) compared to weeks when specimens tested negative for all 3 (3.9% [97/2456]) (aRR = 3.01; 95% CI = 1.77-5.13). Rectal itching was the most common symptom during weeks when participants tested either positive (4.6%) or negative (1.7%); rectal discharge was rare (<1% of weeks). The median duration of symptoms was 1 week for CT and GC and 3 weeks for MG.
Conclusions:
Rectal symptoms are common among persons with rectal GC, CT, and MG infections but are typically mild and of short duration.
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