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Peer-reviewedCC BY-NC-NDSexually Transmitted Diseases

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among Ugandan Adolescents and Adults Vulnerable to HIV

  • Madelaine Ouellette1
  • Natalie Burns2,3
  • Roger Ying2,3
  • Immaculate Nakabuye4
  • Grace Mirembe4
  • Ronald Ephraim Wasswa4
  • Justine Nalunga4
  • Emmanuel Wasswa4
  • Prossy Naluyima4
  • Michelle Imbach2,3
  • Hannah Kibuuka4
  • James Tielsch1
4 more authors
  • Margaret Yacovone5
  • Betty Mwesigwa4
  • Trevor A. Crowell2,3
  • Trevor Crowell
5 affiliations
  1. 1From the Department of Global Health, Milken Institute of Public Health, George Washington University, Washington, DC
  2. 2U.S. Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring
  3. 3Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
  4. 4Makerere University Walter Reed Program, Kampala, Uganda
  5. 5National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD.
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Abstract

BACKGROUND: Chlamydia and gonorrhea are common sexually transmitted infections (STIs) in populations with behavioral vulnerability to HIV. In Uganda, routine syndromic STI management underdiagnoses infections. METHODS: Between October 2022 and September 2024, we enrolled participants in Kampala, Uganda, aged 14-55 years, without HIV, who reported a recent documented STI, injection drug use, transactional sex, condomless sex, or anal sex with males. Urine and anorectal/oropharyngeal swabs were tested for Chlamydia trachomatis and Neisseria gonorrhoeae (Xpert CT/NG, Cepheid). Multivariable robust Poisson regression with purposeful variable selection estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for factors potentially associated with each STI. RESULTS: Among 420 participants with a median age of 21 years (interquartile range 19-24), 241 (57.4%) were female, and 136 (32.4%) were males who have sex with men (MSM). Chlamydia was more prevalent than gonorrhea (21.9% vs. 13.1%, p <0.001). The anorectum was the most common site of infection with 75 chlamydia cases (17.9% [95%CI: 14.5%-21.8%]) and 51 gonorrhea cases (12.1% [9.4%-15.6%]), followed by the urogenital site with 45 chlamydia cases (10.7% [8.1%-14.0%]) and 23 gonorrhea cases (5.5% [3.7%-8.1%]). Urogenital-only screening would have missed 51.1% and 58.2% of chlamydia and gonorrhea cases, respectively, while urogenital+anorectal screening would have missed 1.1% and 0%. Male sex was independently associated with increased prevalence of chlamydia (aPR 2.06 [1.37-3.11], p =0.001) and gonorrhea (PR 2.81 [1.56-5.06], p =0.001). Chlamydia was also more common among participants aged 15-24 years compared to 25-40 (aPR 2.11 [1.02-4.35], p =0.043). CONCLUSIONS: Ugandan healthcare policies should consider anorectal chlamydia and gonorrhea testing, particularly among youth and MSM, to improve STI detection and reduce transmission.

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Cite

BibTeXRIS
BibTeX
@article{ouellette2026prevalence,
  title = {{Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among Ugandan Adolescents and Adults Vulnerable to HIV}},
  author = {Madelaine Ouellette and Natalie Burns and Roger Ying and Immaculate Nakabuye and Grace Mirembe and Ronald Ephraim Wasswa and Justine Nalunga and Emmanuel Wasswa and Prossy Naluyima and Michelle Imbach and Hannah Kibuuka and James Tielsch and Margaret Yacovone and Betty Mwesigwa and Trevor A. Crowell and Trevor Crowell},
  journal = {Sexually Transmitted Diseases},
  year = {2026},
  month = oct,
  doi = {10.1097/olq.0000000000002405},
  url = {https://doi.org/10.1097/olq.0000000000002405},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among Ugandan Adolescents and Adults Vulnerable to HIV
AU  - Madelaine Ouellette
AU  - Natalie Burns
AU  - Roger Ying
AU  - Immaculate Nakabuye
AU  - Grace Mirembe
AU  - Ronald Ephraim Wasswa
AU  - Justine Nalunga
AU  - Emmanuel Wasswa
AU  - Prossy Naluyima
AU  - Michelle Imbach
AU  - Hannah Kibuuka
AU  - James Tielsch
AU  - Margaret Yacovone
AU  - Betty Mwesigwa
AU  - Trevor A. Crowell
AU  - Trevor Crowell
PY  - 2026
DA  - 2026/10/21
JO  - Sexually Transmitted Diseases
DO  - 10.1097/olq.0000000000002405
UR  - https://doi.org/10.1097/olq.0000000000002405
AB  - BACKGROUND: Chlamydia and gonorrhea are common sexually transmitted infections (STIs) in populations with behavioral vulnerability to HIV. In Uganda, routine syndromic STI management underdiagnoses infections. METHODS: Between October 2022 and September 2024, we enrolled participants in Kampala, Uganda, aged 14-55 years, without HIV, who reported a recent documented STI, injection drug use, transactional sex, condomless sex, or anal sex with males. Urine and anorectal/oropharyngeal swabs were tested for Chlamydia trachomatis and Neisseria gonorrhoeae (Xpert CT/NG, Cepheid). Multivariable robust Poisson regression with purposeful variable selection estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for factors potentially associated with each STI. RESULTS: Among 420 participants with a median age of 21 years (interquartile range 19-24), 241 (57.4%) were female, and 136 (32.4%) were males who have sex with men (MSM). Chlamydia was more prevalent than gonorrhea (21.9% vs. 13.1%, p <0.001). The anorectum was the most common site of infection with 75 chlamydia cases (17.9% [95%CI: 14.5%-21.8%]) and 51 gonorrhea cases (12.1% [9.4%-15.6%]), followed by the urogenital site with 45 chlamydia cases (10.7% [8.1%-14.0%]) and 23 gonorrhea cases (5.5% [3.7%-8.1%]). Urogenital-only screening would have missed 51.1% and 58.2% of chlamydia and gonorrhea cases, respectively, while urogenital+anorectal screening would have missed 1.1% and 0%. Male sex was independently associated with increased prevalence of chlamydia (aPR 2.06 [1.37-3.11], p =0.001) and gonorrhea (PR 2.81 [1.56-5.06], p =0.001). Chlamydia was also more common among participants aged 15-24 years compared to 25-40 (aPR 2.11 [1.02-4.35], p =0.043). CONCLUSIONS: Ugandan healthcare policies should consider anorectal chlamydia and gonorrhea testing, particularly among youth and MSM, to improve STI detection and reduce transmission.
SN  - 0148-5717
SN  - 1537-4521
ER  -