High prevalence of Neisseria gonorrhoeae in a remote, undertreated population of Namibian pastoralists

• Published in: Epidemiology and infection Vol. 142; no. 11; pp. 2422 - 2432
• Main Authors: HAZEL, A., PONNALURI-WEARS, S., DAVIS, G. S., LOW, B. S., FOXMAN, B.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.11.2014
• Subjects: Adult; Adults; Age Distribution; Asymptomatic; Bacteria; Bacteriology; Biological and medical sciences; Censuses; Chlamydia; Chlamydia trachomatis; Cross-Sectional Studies; Data collection; Developing Countries; DNA, Bacterial - analysis; Epidemiology; Female; Fundamental and applied biological sciences. Psychology; Gonorrhea; Gonorrhea - diagnosis; Gonorrhea - epidemiology; HIV infections; Humans; Impact, Surveillance and Modelling; Infections; Male; Medically Underserved Area; Men; Microbiology; Middle Aged; Miscellaneous; Namibia - epidemiology; Neisseria gonorrhoeae; Neisseria gonorrhoeae - isolation & purification; Original Papers; Polymerase Chain Reaction - methods; Population density; Poverty; Prevalence; Public Health; Response rates; Risk Assessment; Rural Population; Severity of Illness Index; Sex Distribution; Sexually transmitted diseases; Sexually Transmitted Diseases - epidemiology; Sexually Transmitted Diseases - prevention & control; STD; Symptoms; Towns; Vagina; Young Adult; Namibia; United States > US; Estimating; infectious disease epidemiology; sexually transmitted diseases; prevalence of disease; Neisseria gonorrhoea; public health; Bacteria; Micrococcales; Neisseria gonorrhoeae; Prevalence; Epidemiology; Neisseriaceae
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268813003488

The highly remote pastoralist communities in Kaokoland, Namibia, have long been presumed to have high gonorrhoea prevalence. To estimate gonorrhoea prevalence and correlates of infection, we conducted a cross-sectional study of 446 adults across 28 rural villages. Gonorrhoea status was determined from urethral and vaginal swabs via qPCR assay. All participants answered a closed-ended interview about demographics, sexual behaviour and symptom history. Sixteen per cent of participants had high-level infections (⩾ID50 dose) and 48% had low-level infections (<ID50 dose). Women had higher prevalence than men of both high- and low-level infections. High-level infections were regionally and seasonally clustered, occurring in young adults in the Ehama region during the winter. Low-level infections were distributed homogenously across demographic characteristics, season, and region. All low-level infections and most high-level infections (men 78%, women 95%) were asymptomatic and left untreated. The epidemic-like nature of high-level gonorrhoea cases suggests that intervention efforts can be focused on seasons of high social activity.