Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission

To determine the contribution of Chlamydia trachomatis to nongonococcal ure thritis (NGU) in men attending sexually transmitted disease (STD) clinics i n Jamaica we studied men with NGU (n = 339), and control groups including a symptomatic men who were STD contacts (n = 61), asymptomatic men who were n ot STD contacts (n = 32) and men with gonococcal urethritis (GU) (n = 61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoe ae. Serological tests for syphilis (STS) and HIV-1 infection were also perf ormed. C. trachomatis accounted for 63% of cases of NGU but high prevalence s were also found in asymptomatic STD contacts (59%), asymptomatic STD non- contacts (78%) and men with GU (48%). The prevalence of C. trachomatis in m en with GU differed significantly from that in men with NGU and asymptomati c STD non-contacts (P < 0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71% vs 58%; chi(2) = 4.78; odds rat io (OR) = 1.76; P < 0.05) and previous history of gonococcal infection (83% vs 42%; chi(2) = 59.8; OR = 6.8; P < 0.0001). Concomitant infection with H IV-1 occurred in 5.2% of cases of NGU and 50% and 90%, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strate gy in the control of STD and HN we recommend presumptive treatment for C. t rachomatis in men seeking STD treatment in Jamaica.