Etiological surveillance of Male Urethritis Syndrome in South Africa: 2019-2020

• Published in: Sexually transmitted diseases
• Main Authors: Kularatne, Ranmini, Maseko, Venessa, Mahlangu, Precious, Muller, Etienne, Kufa, Tendesayi
• Format: Journal Article
• Language: English
• Published: United States 01.08.2022
• ISSN: 1537-4521
• DOI: 10.1097/OLQ.0000000000001647

In South Africa, male urethritis syndrome (MUS) is the most common STI syndrome in men). We determined the distribution of STI etiologies and the susceptibility profiles of Neisseria gonorrhoeae isolates from men presenting with MUS to three sentinel surveillance PHCs. Secondary objectives were to determine the seroprevalence of co-infections (HIV, syphilis, herpes simplex virus-2). Consecutive, consenting men with symptomatic urethral discharge were enrolled between 01 January 2019 and 31 December 2020. Genital discharge swab and blood specimens were collected and transported to a central STI reference laboratory in Johannesburg. Among 769 men enrolled, N. gonorrhoeae was the commonest cause of MUS (674, 87.8%; 95% CI 85.2 - 89.9), followed by C. trachomatis (161, 21.0%; 95% CI 18.2 - 24.0). Of 542 cultivable N. gonorrhoeae isolates, all were susceptible to ceftriaxone (modal MIC 0.004 mg/L) and azithromycin (modal MIC 0.128 mg/L). Seroprevalence of HIV, syphilis and HSV-2 was 21.4% (95%CI 18.5 - 24.5); 2.3%, and 50.1%, respectively. Condom use at last sexual encounter was reported by only 7%, less than 50% had been medically circumcised, and only 66.7% (58/87) who self-reported an HIV-positive status were adherent on ARVs. N. gonorrhoeae and C. trachomatis were the predominant causes of MUS. Currently recommended dual ceftriaxone and azithromycin therapy are appropriate for MUS syndromic management; however surveillance must be maintained to timeously detect emerging and increasing gonococcal resistance. Clinic-based interventions must be intensified in men seeing sexual healthcare in order to reduce the community transmission and burden of STI and HIV.