Prevalence and associated risk factors of chlamydia and gonorrhoea infections among men who have sex with men in Durban, South Africa

Kehinde C. Mofolorunsho, Nonkululeko Mabaso, Nikita Nundlall, Apiwe Nightingale, Makandwe Nyirenda, Nathlee Abbai


Despite significant research on the prevalence of STIs in South African men who have sex with men (MSM), recent data on the prevalence and risk factors for curable STI infections among this key populations are limited. This study determined the prevalence of and risk factors associated with Neisseria gonorrhoeae and Chlamydia trachomatis infections among MSM. The sample consisted of 200 MSM resident in Durban. Data were collected using a self-administered questionnaire, and urine samples were collected and tested for N. gonorrhoeae and C. trachomatis. The prevalence of N. gonorrhoeae and C. trachomatis were 3.0% and 6.0%, respectively. Younger age was significantly associated with testing positive for C. trachomatis (p=0.037). Being between the ages of 30-39 years old reduced the risk of acquiring C. trachomatis infection (OR: 0.10, 95% CI: 0.0120-0.7564, p=0.026). In addition, being circumcised reduced the risk of contracting C. trachomatis (adjusted OR: 0.01, 95% CI: 0.0005-0.3516, p=0.01). However, having between 2-4 sex partners increased the risk of testing positive for C. trachomatis (adjusted OR: 107.45, 95% CI: 1.3467- 8573.3130, p=0.036). The following factors were significantly associated (p<0.05) with testing positive for N. gonorrhoeae infection: cohabiting with sex partner, engaging in group sex, and drug use. Fear and stigma were the main barriers to accessing health care in the studied population. This study provided evidence of high rates of C. trachomatis infection among MSM resident in Durban. Based on the results, South African MSM, especially the young MSM population, should be given priority when delivering intervention programs to prevent STIs. (Afr J Reprod Health 2024; 28 [4]: 90-110)

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Jones KG, Johnson AM, Wellings K, Sonnenberg P, Field N,

Tanton C, Erens B, Clifton S, Datta J, Mitchell KR,

Prah P and Mercer CH. The prevalence of, and factors

associated with, paying for sex among men resident in

Britain: Findings from the third National Survey of

Sexual Attitudes and Lifestyles (Natsal-3). Sex

Transm Infect 2015; 91: 116–123.

Hu H, Chen Y, Shi L, Liu X, Xu Z, Sun L, Zhao X, Zhou Y,

Lu J, Zhang Z, Liu X and Fu G. Prevalence of Syphilis

and Chlamydia trachomatis infection among men who

have sex with men in Jiangsu province, China: A

cross-sectional survey. Front Public Health 2022; 10:

World Health Organization. Sexually transmitted infections

(STIs): Key facts [Internet]. 2019,

(2019, accessed 17 April 2023).

Workowski KA and Bachmann LH. Centers for Disease

Control and Prevention’s sexually transmitted

diseases infection guidelines. Clinical Infectious

Diseases 2022; 74(2): S89–S94,

Newman L, Rowley J, Hoorn SV, Wijesooriya NS, Unemo

M, Low N, Stevens G, Gottlieb S, Kiarie J and

Temmerman M. Global estimates of the prevalence

and incidence of four curable sexually transmitted

infections in 2012 based on systemic review and

global reporting. PLoS ONE 2015; 10: e0143304.

Centers for Disease Control and Prevention. Sexually

transmitted disease surveillance [Internet]. 2019, (2019, accessed 20 April


Workowski KA and Bolan GA. Centers for Disease Control

and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep

; 64: 1–137.

Aboud S, Buhalata SN, Onduru OG, Chiduo MG, Kwesigabo

GP, Mshana SE, Manjurano AM, Temu MM,

Kishamawe C and Changalucha JM. High prevalence

of sexually transmitted and reproductive tract

infections (STI/RTIS) among patients attending

STI/outpatient department clinics in Tanzania. Trop

Med Infect Dis 2023; 8: 62.

World Health Organization. Global Progress Report on HIV,

Viral Hepatitis and Sexually Transmitted Infections,

[Internet]. 2021, Available online at:

/9789240030985-eng.pdf (2021, accessed 17 April


World Health Organization. Global health sector strategy on

sexually transmitted infections 2016-2021: toward

ending STIs, in In Global health sector strategy on

sexually transmit- ted infections 2016-2021: toward

ending STIs, WHO. 2016, Available online at: (2016, accessed 17 April 2023).

Unemo M, Bradshaw CS, Hocking JS, de Vries HJC,

Francis SC, Mabey D, Marrazzo JM, Sonder GJB,

Schwebke JR, Hoornenborg E, Peeling RW, Philip

SS, Low N and Fairley CK. Sexually transmitted

infections: challenges ahead. The Lancet Infectious

Diseases 2017; 17(8): e235–e279.

Cohen MS. Sexually transmitted diseases enhance HIV

transmission: no longer a hypothesis. Lancet 1998;

: 5–7.


Vodstrcil LA, Fairley CK, Fehler G, Leslie D, Walker J,

Bradshaw CS, and Hocking JS. Trends in chlamydia

and gonorrhoea positivity among heterosexual men

and men who have sex with men attending a large

urban sexual health service in Australia, 2002–2009.

BMC Infect Dis 2011; 11: 158.

Fu GF, Jiang N, Hu HY, Mahapatra T, Yin YP, Mahapatra

S, Wang XL, Chen XS, Babu GR, Xu XQ, Ding P,

Qiu T, Liu XY, Guo H, Huan XP and Tang W. The

epidemic of HIV, syphilis, chlamydia and gonorrhoea

and the correlates of sexual transmitted infections

among men who have sex with men in Jiangsu, China,

PLoS ONE 2015; 10: e0118863.

Rob F, Juzlov愃Ā K, Kru娃ఀicov愃Ā Z, Vanousov愃Ā D, L愃Āsikov愃Ā 匃ఀ,

S礃Ākorov愃Ā B, Machala L, Rozsypal H, Vesely D,

Zákouckà H and Hercogová J. Prevalence of

Chlamydia trachomatis and Neisseria gonorrhoeae

co-infections among patients with newly diagnosed

syphilis: a single-centre, cross-sectional study. Cent

Eur J Public Health 2019; 27: 285–91.

Peeling RW, Mabey D, Kamb ML, Chen XS, Radolf JD and

Benzaken AS. Syphilis. Nat Rev Dis Primers 2017; 3:

Remis RS, Liu J, Loutfy MR, Tharao W, Rebbapragada A,

Huibner S, Kesler M, Halpenny R, Grennan T,

Brunetta J, Smith G, Reko T and Kaul R. Prevalence

of sexually transmitted viral and bacterial infections in

HIV- positive and HIV-negative men who have sex

with men in Toronto. PLoS One 2016; 11: e0158090.

Spicknall IH, Gift TL, Bernstein KT and Aral SO. Sexual

networks and infection transmission networks among

men who have sex with men as causes of disparity and

targets of prevention. Sex Transm Infect 2017; 93:

– 8.

Paz-Bailey G, Mendoza MC, Finlayson T, Wejnert C, Le B,

Rose C, Raymond HF and Prejean J. Trends in

condom use among MSM in the United States: the role

of antiretroviral therapy and sero-adaptive strategies.

AIDS 2016; 30: 1985–90.

Zhou Y, Cai YM, Li SL, Cao NX, Zhu XF, Wang F, Han Y,

Yin YP and Chen XS. Anatomical site prevalence and

genotypes of Chlamydia trachomatis infections

among men who have sex with men: a multi-site study

in China. BMC Infect Dis 2019; 19: 1041.

Peters RP, Verweij SP, Nijsten N, Ouburg S, Mutsaers J,

Jansen CL, van Leeuwen AP and Morré SA.

Evaluation of sexual history-based screening of

anatomic sites for Chlamydia trachomatis and

Neisseria gonorrhoeae infection in men having sex

with men in routine practice. BMC Infect Dis 2011;

: 203.

Blondeel K, Say L, Chou D, Toskin I, Khosla R, Scolaro E

and Temmerman M. Evidence and knowledge gaps on

the disease burden in sexual and gender minorities: a

review of systematic reviews. Int J Equity Health

; 15: 16.


Mitchell H, Allen H, Sonubi T, Kuyumdzhieva G, Harb A,

Shah A, Glancy M, Checchi M, Milbourn H, Folkard

K, Mohammed H and contributors. Sexually

transmitted infections and screening for Chlamydia in

England, 2019. Public Health England [Internet].



/STI_ NCSP_report_2019.pdf (2019, accessed 20

April 2023).

Bignell C and Unemo M. 2012 European guideline on the

diagnosis and treatment of gonorrhoea in adults. Int J

STD AIDS 2013; 24: 85–92.

Ribeiro S, de Sousa D, Medina D, Castro R, Lopes  and

Rocha M. Prevalence of gonorrhoea and chlamydia in

a community clinic for men who have sex with men in

Lisbon, Portugal. Int J STD AIDS 2019; 30(10): 951-

Mohseni M, Sung S, and Takov V. Chlamydia. (Updated

. In: StatPearls [Internet]. Treasure Island (FL):

StatPearls Publishing; 2023,

(2023, accessed 19 April 2023).

Bernstein KT, Marcus JL, Nieri G, Philip SS and Klausner

JD. Rectal gonorrhoea and chlamydia reinfection is

associated with increased risk of HIV seroconversion.

J Acquir Immune Defic Syndr 2010; 53: 537–43.

Stöppler MC. 9 Common Sexually Transmitted Diseases in

Men. MedicineNet [Internet]. 2023,

w/article.htm (2023, accessed 19 April 2023).

Kaul R, Nagelkerke NJ, Kimani J, Ngugi E, Bwayo JJ,

Macdonald KS, Rebbaprgada A, Fonck K,

Temmerman M, Ronald AR, Moses S and Kibera HIV

Study Group. Prevalent herpes simplex virus type 2

infection is associated with altered vaginal flora and

an increased susceptibility to multiple sexually

transmitted infections. J Infect Dis 2007; 196: 1692–

Götz HM, van Doornum G, Niesters HG, den Hollander JG,

Thio HB and de Zwart O. Cluster of acute hepatitis C

virus infection among men who have sex with men–

results from contact tracing and public health

implications. AIDS 2005; 19: 969–74.


Dreyer G. Clinical implications of the interaction between

HPV and HIV infections. Best Pract Res Clin Obstet

Gynaecol 2018; 47: 95–106.

Ward H, Martin I, Macdonald N, Alexander S, Simms I,

Fenton K, French P, Dean G and Ison C.

Lymphogranuloma venereum in the United kingdom.

Clin Infect Dis 2007; 44: 26–32.

Ye Z-H, Chen S, Liu F, Cui S-T, Liu Z-Z, Jiang Y-J and Hu

Q-H. Patterns of sexually transmitted co-infections

and associated factors among men who have sex with

men: a cross-sectional study in Shenyang, China.

Front Public Health 2022; 10: 842644.

Chan PA, Robinette A, Montgomery M, Almonte A, CuUvin S, Lonks JR Chapin KC, Kojic EM and Hardy

EJ. Extragenital infections caused by Chlamydia

trachomatis and Neisseria gonorrhoeae: A review of

the literature. Infect Dis Obstet Gynecol 2016; 2016:

Kharsany B, Cawood C, Lewis L, Yende-Zuma N, Khanyile

D, Puren A, Madurai S, Baxter C, George G,

Govender K, Beckett S, Samsunder N, Toledo C,

Ayalew KA, Diallo K, Glenshaw M, Herman-Roloff

A, Wilkinson E, de Oliveira T, Abdool Karim SS and

Abdool Karim Q. Trends in HIV prevention,

treatment, and incidence in a hyperendemic area of

KwaZulu-Natal, South Africa. JAMA Network Open

; 2(11): e1914378–e1914378.

Naidoo S, Wand H, Abbai NS, and Ramjee G. High

prevalence and incidence of sexually transmitted

infections among women living in Kwazulu-Natal,

South Africa. AIDS Research and Therapy 2014;

(1): 31–31.


Nel A, Mabude Z, Smit J, Kotze P, Arbuckle D, Wu J, van

Niekerk N, and van de Wijgert J. HIV incidence

remains high in KwaZulu-Natal, South Africa:

evidence from three districts. Plos One 2012; 7(4):


University of California, San Francisco. Report of the South

Africa men-who-have-sex with-men Data

Triangulation Project. San Francisco: UCSF. Global

Health Sciences. 2015, ( 2015, accessed 19 April 2023).

Cloete A, Simbayi LC, Rehle T, Jooste S, Mabaso M,

Townsend L, Ntsepe Y, LouwJ, Naidoo D, Duda T,

Naidoo P and the Marang Men’s Project Team. The

South African Marang Men’s Project: HIV biobehavioural surveys using respondent-driven

sampling conducted among men who have sex with

men in Cape Town, Durban and Johannesburg. Cape

Town: HSRC Press [Internet]. 2014,




_and_Johannesburg_using_respondentdriven_sampling ( 2014, accessed 19 April 2023).

Rispel LC, Metcalf CA, Cloete A, Reddy V, and Lombard

C. HIV prevalence and risk practices among men who

have sex with men in two South African cities. J

Acquir Immune Defic Syndr 2011; 57(1): 69-76.

Mashingaidze R, Moodie Z, Allen M, Bekker L-G, Grove D,

Grunenberg N, Huang Y, Janes HE, Lazarus EM,

Malahleha M, Nchabeleng M and Laher F. Sexually

transmitted infections amongst men who have sex

with men (MSM) in South Africa. PLOS Glob Public

Health 2023; 3(4): e0001782.

Jones J, Sanchez TH, Dominguez K, Bekker LG, Phaswana-Mafuya N, Baral SD, McNaghten

AD, Kgatitswe L, Valencia R, Yah CS, Zahn

R, Siegler AJ and Sullivan PS. Sexually transmitted

infection screening, prevalence and incidence among

South African men and transgender women who have

sex with men enrolled in a combination HIV

prevention cohort study: the Sibanye Methods for

Prevention Packages Programme (MP3) project. J Int

AIDS Soc 2020; 23(S6): e25594.

Rebe K, Lewis D, Myer L, de Swardt G, Struthers H,

Kamkuemah M and McIntyre J. A cross sectional

analysis of gonococcal and chlamydial infections

among men-who-have-sex-with-men in Cape Town,

South Africa. PLoS One 2015; 10(9): e0138315.


Hançali A, Bellaji B, Jennane S, Soraa N, Bennani A,

Ghargui L, Rhilani H, Alami K and Rhajaoui M. P539

Prevalence of Chlamydia trachomatis and Neisseria

gonorrhoeae among MSM in Morocco. Sex Transm

Infect 2019; 95: A244.

Ross MW, Nyoni J, Ahaneku HO, Mbwambo J, McClelland

RS, and McCurdy SA. High HIV seroprevalence,

rectal STIs and risky sexual behaviour in men who

have sex with men in Dar es Salaam and Tanga,

Tanzania. BMJ Open 2014; 4(8): e006175.

Wong HTH, Wong KH, Lee SS, Leung RWM, and Lee

KCK. Community-based surveys for determining the

prevalence of HIV, Chlamydia, and Gonorrhoea in

men having sex with men in Hong Kong. J Sex

Transm Dis 2013; 958967: 1-8.

Mimiaga MJ, Helms DJ, Reisner SL, Grasso C, Bertrand T,

Mosure DJ, Weinstock H, McLean C and Mayer KH.

Gonococcal, chlamydia, and syphilis infection

positivity among MSM attending a large primary care

clinic, Boston, 2003 to 2004. Sex Transm Dis 2009;

(8): 507–511.

Sanders EJ, Thiong’o AN, Okuku HS, Mwambi J, Priddy F,

Shafi J, de Vries H, McClelland RS and Graham SM.

High prevalence of Chlamydia trachomatis and

Neisseria gonorrhoeae infections among HIV-1

negative men who have sex with men in coastal

Kenya. Sex Transm Infect 2010; 86: 440–1.

Tongtoyai J, Todd CS, Chonwattana W, Pattanasin S,

Chaikummao S, Varangrat A, Lokpichart S, Holtz TH,

van Griensven F, and Curlin ME. Prevalence and

correlates of Chlamydia trachomatis and Neisseria

gonorrhoeae by anatomic site among urban Thai men

who have sex with men. Sex Transm Dis 2015; 42(8):


Yang LG, Zhang XH, Zhao PZ, Chen ZY, Ke WJ, Ren XQ

Wang LY, Chen WY and Tucker JD. Gonorrhea and

chlamydia prevalence in different anatomical sites

among men who have sex with men: a cross-sectional

study in Guangzhou, China. BMC Infect Dis 2018;

: 675.

Adamson PC, Bhatia R, Tran KDC, Bui HTM, Vu D,

Shiraishi RW and Giang LM. Prevalence, anatomic

distribution, and correlates of Chlamydia trachomatis

and Neisseria gonorrhoeae infections among a cohort

of men who have sex with men in Hanoi, Vietnam.

Sex Transm Dis 2022; 49: 504–10.

Benn PD, Rooney G and Carderetal, C. Chlamydia

trachomatis and Neisseria gonorrhoeae infection and

the sexual behaviour of men who have sex with men.

Sex Transm Infect 2007; 83(2): 106–112.

Jansen K, Steffen G, Potthoff A, Schuppe AK, Beer D,

Jessen H, Scholten S, Spornraft-Ragaller P, Bremer V,

Tiemann C and MSM Screening Study group. STI in

times of PrEP: high prevalence of chlamydia,

gonorrhoea, and mycoplasma at different anatomic

sites in men who have sex with men in

Germany. BMC Infect Dis 2020; 20: 110.

Mwaniki SW, Kaberia PM, Mugo PM and Palanee-Phillips

T. Prevalence of five curable sexually transmitted

infections and associated risk factors among tertiary

student men who have sex with men in Nairobi,

Kenya: a respondent-driven sampling survey. Sex

Health 2023; 20(2): 105-117.

Dewart CM, Bernstein KT, DeGroote NP, Romaguera R and

Turner AN. Prevalence of rectal chlamydial and

gonococcal infections: a systematic review. Sex

Transm Dis 2018; 45(5): 287–93.

Kularatne RS, Niit R, Rowley J, Kufa-Chakezha T, Peters

RPH, Taylor MM, Johnson LF, and Korenromp EL.

Adult gonorrhea, chlamydia and syphilis prevalence,

incidence, treatment and syndromic case reporting in

South Africa: Estimates using the Spectrum-STI

model, 1990–2017. PLoS ONE 2018; 13(10):


Debattista J, Clementson C, Mason D, Dwyer J, Argent S,

Woodward C, Dean J, Buks L, Copley M, Hinwood

G, Benfield C and Walton P. Screening for Neisseria

gonorrhoeae and Chlamydia trachomatis at

entertainment venues among men who have sex with

men. Sex Transm Dis 2002; 29(4): 216–221.

Lister NA, Smith A, Tabrizi S, Hayes P, Medland NA,

Garland S and Fairley CK. Screening for Neisseria

gonorrhoeae and Chlamydia trachomatis in men who

have sex with men at male-only saunas. Sex Transm

Dis 2003; 30(12): 886–889.

Aitlhaj-Mhand R, Bellaji B, Jennane S, Remz C, Charof R,

Khoudri I, Kettani A, El Rhilani H, Alami K, Ghargui

L, Youbi M, Abdelmoumen H, Hançali A and Oumzil

H. Assessment of Chlamydia trachomatis, Neisseria

gonorrhoeae and Trichomonas vaginalis prevalence

using a molecular Point of Care: Findings from a

respondent driven sampling study among MSM. Infez

Med 2023; 31(2): 234-242.

Chow EPF, Jing J, Feng Y, Min D, Zhang J, Wilson DP,

Zhang X and Zhang L. Pattern of HIV testing and

multiple sexual partnerships among men who have sex

with men in China. BMC Infect Dis 2013; 13: 549.

Chow EPF, Camilleri S, Ward C, Huffam S, Chen MY,

Bradshaw CS and Fairley CK. Duration of gonorrhoea

and chlamydia infection at the pharynx and rectum

among men who have sex with men: a systematic

review. Sex Health 2016; 13(3): 199–204.

Calas A, Zemali N, Camuset G, Jaubert J, Manaquin R,

Saint-Pastou C, Koumar Y, Poubeau P, Gerardin P

and Bertolotti A. Prevalence of urogenital, anal, and

pharyngeal infections with Chlamydia

trachomatis, Neisseria gonorrhoeae,

and Mycoplasma genitalium: a cross-sectional study

in Reunion island. BMC Infect Dis. 2021; 21: 95.

Budkaew J, Chumworathayi B, Pientong C and

Ekalaksananan T. Prevalence and factors associated

with gonorrhoea infection with respect to anatomic

distributions among men who have sex with men.

PLoS ONE 2019; 14(4): e0211682.

Shafer MA, Boyer CB, Shaffer RA, Schachter J, Ito SI and

Brodine SK. Correlates of sexually transmitted

diseases in a young male deployed military

population. Mil Med 2002; 167: 496–500.

Galvin SR and Cohen MS. The role of sexually transmitted

diseases in HIV transmission. Nat Rev Microbiol

; 2: 33-42.

Berman SM and Cohen MS. STD treatment: how can it

improve HIV prevention in the South? Sex Transm

Dis 2006; 33: S50-7.

Cheung KT, Fairley CK, Read TR, Denham I, Fehler G,

Bradshaw CS, Chen MY and Chow EP. HIV

incidence and predictors of incident HIV among men

who have sex with men attending a sexual health

clinic in Melbourne, Australia. PLoS One 2016; 11:


Pathela P, Braunstein SL, Blank S, Shepard C and

Schillinger JA. The high risk of an HIV diagnosis

following a diagnosis of syphilis: a population-level

analysis of New York City men. Clin Infect Dis 2015;

: 281–7.

Katz DA, Dombrowski JC, Bell TR, Kerani RP and Golden

MR. HIV incidence among men who have sex with

men after diagnosis with sexually transmitted

infections. Sex Transm Dis 2016; 43:249–54.

Harney BL, Agius PA, El-Hayek C, Fairley CK, Chow EPF,

Roth N, Tee BK, Leslie D, Tachedjian G, Hellard M

and Stoové M. Risk of subsequent HIV infection

following sexually transmissible infections among

men who have sex with men. Open Forum Infect Dis

; 6(10): ofz376.

Ghebremichael M and Paintsil E. High risk behaviours and

sexually transmitted infections among men in

Tanzania. AIDS Behav 2011; 15(5): 1026–32.

Savage EJ, Marsh K, Duffell S, Ison CA, Zaman A and

Hughes G. Rapid increase in gonorrhoea and syphilis

diagnoses in England in 2011. Euro Surveill 2012;

(29) :pii=20224.

Castillo R, Konda KA, Leon SR, Silva-Santisteban A,

Salazar X, Klausner JD, Coates TJ, and Cáceres CF.

HIV and sexually transmitted infection incidence and

associated risk factors among high-risk MSM and

male-to-female transgender women in Lima, Peru. J

Acquir Immune Defic Syndr 2015; 69: 567–575.

Dudareva-Vizule S, Haar K, Sailer A, Wisplinghoff H,

Wisplinghoff F and Marcus U. Prevalence of

pharyngeal and rectal Chlamydia trachomatis and

Neisseria gonorrhoeae infections among men who

have sex with men in Germany. Sex Transm Infect

; 90: 46–51.

Jones MLJ, Chapin-Bardales J, Bizune D, Papp JR, Phillips

C, Kirkcaldy RD, Wejnert C, Bernstein KT, and

National HIV behavioural surveillance sexually

transmitted infection study group. Extragenital

chlamydia and gonorrhoea among community venue–

attending men who have sex with men, five cities,

united states, 2017. MMWR Morb Mortal Wkly Rep

; 68(14): 321–325.

Dutt K, Chow Eric PF, Haffam S, Klassen K, Fairley CK,

Bradshaw CS, Denham I and Chen MY. High

prevalence of rectal gonorrhoea among men reporting

contact with men with gonorrhoea: Implications for

epidemiological treatment. BMC Public Health 2015;

: 658.

Dallabetta G, Wi TEC, and Nielsen G. Prevention and

control of STD and HIV infection in developing

countries. In: Holmes KK, Sparling PF, Stamm WE,

Piot P, Wasserheit JN, Corey L, Cohen M, and Watts

H (eds.). Sexually transmitted diseases 4th edn. New

York, NY: McGraw-Hill; 2008.

Esser S, Krotzek J, Dirks H, Scherbaum N and Schadendorf

D. Sexual risk behaviour, sexually transmitted

infections, and HIV transmission risks in HIVpositive men who have sex with men (MSM)—

approaches for medical prevention. J Dtsch Dermatol

Ges 2017; 15(4): 421–428.

Corsenac P, Noël M, Rouchon B, Hoy D and Roth A.

Prevalence and sociodemographic risk factors of

chlamydia, gonorrhoea and syphilis: a national

multicentre STI survey in New Caledonia, 2012. BMJ

Open 2015; 5: e007691.

Slurink IA, Götz HM, van Aar F and van Benthem BH.

Educational level and risk of sexually transmitted

infections among clients of Dutch sexual health

centres. Int J STD AIDS 2021; 32(11): 1004-1013.

Centers for Disease Control and Prevention (CDC).

Gonorrhea–CDC Fact Sheet [Internet]. 2023, ( 2023, accessed 29 August 2023).

Duby Z, Nkosi B, Scheibe A, Brown B and Bekker L-G.

Scared of going to the clinic: contextualising

healthcare access for men who have sex with men,

female sex workers and people who use drugs in two

South African cities. S Afr J HIV Med 2018; 19(1):


van Liere GA, Hoebe CJ and Dukers-Muijrers NH.

Evaluation of the anatomical site distribution of

chlamydia and gonorrhoea in men who have sex with

men and in high-risk women by routine testing: crosssectional study revealing missed opportunities for

treatment strategies. Sex Transm Infect 2013; 90: 58–

van Liere GA, Hoebe CJ, Niekamp AM, Koedijk FD and

Dukers-Muijrers NH. Standard symptom- and sexual

history-based testing misses anorectal Chlamydia

trachomatis and Neisseria gonorrhoeae infections in

swingers and men who have sex with men. Sex Transm Dis 2013; 40: 285–289.

van Liere GA, Hoebe CJ, Wolffs PF and Dukers-Muijrers

NH. High co-occurrence of anorectal chlamydia with

urogenital chlamydia in women visiting an STI clinic

revealed by routine universal testing in an

observational study; a recommendation towards a

better anorectal chlamydia control in women. BMC

Infect Dis 2014; 14: 274.

Edwards S and Carne C. Oral sex and transmission of nonviral STIs. Sex Transm Infect 1998; 74: 95–

Prestage G, Down I, Grulich A and Zablotska I. Sex partying

among gay men in Sydney, Melbourne and Brisbane,

Australia. AIDS Behav 2011; 15(2): 298–304.

Goedel WC and Duncan DT. Correlates of engagement in

group sex events among men who have sex with men

in London who use geosocial- networking smartphone

applications. Int J STD AIDS 2018; 29(3): 244–50.

Phillips G, Magnus M, Kuo I, Rawls A, Peterson J, WestOjo T, Jia Y, Opoku J and Greenberg AE. Correlates

of group sex among a community-based sample of

men who have sex with men (MSM) in Washington,

DC. AIDS Behav 2014; 18: 1413–9.

Mimiaga MJ, Reisner SL, Bland SE, Driscoll MA, Cranston

K, Isenberg D, Van Derwarker R and Mayer KH. Sex

parties among urban MSM: an emerging culture and

HIV risk environment. AIDS Behav 2011; 15(2):


Prestage GP, Hudson J, Jin F, Corrigan N, Martin P,

Grulich AE and McInnes D. Testing for HIV and

sexually transmissible infections within a mainly

online sample of gay men who engage in group sex.

Sex Transm Infect 2009; 85: 70–74.

Mimiaga MJ, Reisner SL, Bland S, Cranston K, Isenberg D,

Driscoll MA, VanDerwarker R and Mayer KH. It’s a

quick way to get what you want: a formative

exploration of HIV risk among urban Massachusetts

men who have sex with men who attend sex parties.

AIDS Patient Care STDS 2010; 24: 659–674.

Rosenberger JG, Reece M, Schick V, Herbenick D, Novak

DS, Van Der Pol B and Fortenberry JD. Sexual

behaviours and situational characteristics of most

recent male-partnered sexual event among gay and

bisexually identified men in the United States. J Sex

Med 2011; 8: 3040–3050.

Grov C, Rendina HJ, Ventuneac A and Parsons JT. HIV risk

in group sexual encounters: an event-level analysis

from a national online survey of MSM in the U.S. J

Sex Med 2013; 10(9): 2285–94.

Friedman SR, Bolyard M, Khan M, Maslow C, Sandoval M,

Mateu-Gelabert P, Krauss B and Aral SO. Group sex

events and HIV/STI risk in an urban network. J Acquir

Immune Defic Syndr 2008; 49(4): 440–6.

Rice CE, Lynch CD, Norris AH, Davis JA, Fields KS, Ervin

M and Turner AN. Group sex and prevalent sexually

transmitted infections among men who have sex with

men. Arch Sex Behav 2016; 45(6): 1411–9.

van den Boom W, Davidovich U, Heuker J, Lambers F,

Prins M, Sandfort T and Stolte IG. Is group sex a

higher-risk setting for HIV and other sexually

transmitted infections compared with dyadic sex

among men who have sex with men? Sex Transm Dis

; 43(2): 99–104.

Scheidell JD, Friedman SR, Golin C, Wohl DA and Khan

MR. Group sex event participation: a link to STI risk

among African-American heterosexual men

incarcerated in North Carolina. Sex Transm Infect

; 93(2): 144.

Abara WE, Oraka E, Jeffries WL, Chavez P, Nasrullah M,

and DiNenno E. Prevalence and correlates of condom

use among sexually active men who have sex with

men in the United States: findings from the National

Survey of Family Growth, 2002, 2006–10 and 2011–

Sex Health 2017; 14: 363-371.

Adam BD, Husbands W, Murray J and Maxwell J. AIDS

optimism, condom fatigue, or self-esteem? Explaining

unsafe sex among gay and bisexual men. J Sex Res

; 42: 238–48.

Mansergh G, Naorat S, Jommaroeng R, Jenkins RA, Stall

R, Jeeyapant S, Phanuphak P, Tappero JW and van

Griensven F. Inconsistent condom use with steady and

casual partners and associated factors among

sexually-active men who have sex with men in

Bangkok, Thailand. AIDS Behav 2006; 10: 743–51.

Lee W, Daniel RN, Harland DA, Mary LK, John MD,

Malotte CK, Jonathan MZ, Judy R, Gail B, Martin F,

David GK, Maurizio M and Thomas AP. Condom

effectiveness for reducing transmission of gonorrhoea

and chlamydia: the importance of assessing partner

infection status. Am J Epidemiol 2004; 159: 242–25.

Werber D, Michaelis K, Hausner M, Sissolak D, Wenzel J,

Bitzegeio J, Belting A, Sagebiel D and Faber M.

Ongoing out-breaks of hepatitis A among men who

have sex with men (MSM), Berlin, November 2016 to

January 2017—linked to other German cities and

European countries. Euro Surveill 2017; 22(5): 30457.


Mehta KS, Marfatia YS, Jain AP, Shah DJ and Baxi DS.

Male circumcision and Sexually transmitted

infections – An update. Indian J Sex Transm Dis

AIDS 2021; 42(1) :1-6.

Bailey RC, Moses S, Parker CB, Agot K, Maclean I,

Krieger JN, Williams CF, Campbell RT, and Ndinya- Achola JO. Male circumcision for HIV prevention in

young men in Kisumu, Kenya: a randomised

controlled trial. Lancet 2007; 369(9562): 643-56.

Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S,

Nalugoda F, Kiwanuka N, Moulton LH, Chaudhary

MA, Chen MZ and Sewankambo NK. Male

circumcision for HIV prevention in men in Rakai,

Uganda: a randomised trial. Lancet 2007; 369(9562):



Sobngwi-Tambekou J, Taljaard D, Nieuwoudt M, Lissouba

P, Puren A and Auvert B. Male circumcision and

Neisseria gonorrhoeae, Chlamydia trachomatis and

Trichomonas vaginalis: observations after a

randomised controlled trial for HIV prevention. Sex

Transm Infect 2009; 85(2): 116-20.

Yuan T, Fitzpatrick T, Ko N-Y, Cai Y, Chen Y, Zhao J, Li

L, Xu J, Gu J, Li J, Hao C, Yang Z, Cai W, Cheng CY,

Luo Z, Zhang K, Wu G, Meng X, Grulich, AE, Hao Y

and Zou H. Circumcision to prevent HIV and other

sexually transmitted infections in men who have sex

with men: a systematic review and meta-analysis of

global data. Lancet Glob Health 2019; 7(4): e436-


Sharma SC, Raison N, Khan S, Shabbir M, Dasgupta P and

Ahmed K. Male circumcision for the prevention of

human immunodeficiency virus (HIV) acquisition: a

meta-analysis. BJU Int 2018; 121(4): 515-526.

Iyemosolo, BM, Chivese T and Esterhuizen, TM. A

comparison of the prevalence of sexually transmitted

infections among circumcised and uncircumcised

adult males in Rustenburg, South Africa: a crosssectional study. BMC Public Health 2021; 21: 656.

Diseker RA 3rd, Peterman TA, Kamb ML, Kent C,

Zenilman JM, Douglas JM Jr, Rhodes F and Iatesta

M. Circumcision and STD in the United States: cross

sectional and cohort analyses. Sex Transm Infect

; 76: 474-9.

WHO/UNAIDS Technical consultation on male

circumcision and HIV prevention: Research

implications for policy and programming Montreux,

-8 March 2007 [Internet]. 2007, (2007,

accessed 17 August 2023).

Jin F, Prestage GP, Mao L, Kippax SC, Pell CM, Donovan

B, Cunningham PH, Templeton DJ, Kaldor JM and

Grulich AE. Incidence and risk factors for urethral and

anal gonorrhoea and chlamydia in a cohort of HIVnegative homosexual men: the health in men study.

Sex Transm Infect 2007; 83: 113–119.

van Liere GAFS, van Rooijen MS, Hoebe CJPA, Heijman

T, de Vries HJC and Dukers-Muijrers NHTM.

Prevalence of and factors associated with rectal-only

chlamydia and gonorrhoea in women and in men who

have sex with men. PLoS ONE 2015; 10(10):


Allan-Blitz LT, Leon SR, Bristow CC, Konda KA, Vargas

SK, Flores JA, Brown BJ, Caceres CF and Klausner

JD. High prevalence of extra-genital chlamydial or

gonococcal infections among men who have sex with

men and transgender women in Lima, Peru. Int J STD

AIDS 2017; 28(2): 138-144.

Cunha CB, Friedman RK, de Boni RB, Gaydos C,

Guimarães MR, Siqueira BH, Cardoso SW,

Chicayban L, Coutinho JR, Yanavich C, Veloso VG

and Grinsztejn B. Chlamydia trachomatis, Neisseria

gonorrhoeae and syphilis among men who have sex

with men in Brazil. BMC Public Health 2015; 15: 686.

Ananworanich J, Chitwarakorn A, Wimonsate W,

Varangrat A, Chaikummao S, Sriporn A, Tongtoyai J,

Mock P, Sukwicha W, Chonwattana W, Luechai P,

Curlin M, McNicholl J, Holtz T and van Griensven F.

HIV and syphilis infection among men who have sex

with men - Bangkok, Thailand, 2005–2011. MMWR

Morb Mortal Wkly Rep 2013; 62: 518–20.

PMCID: PMC4604950.

Ruchika K, Walter PK, Timona O, William S and Gunturu

R. Prevalence of genital chlamydia infection in urban

women of reproductive age, Nairobi, Kenya. BMC

Res Notes 2013; 6: 44.


Machouf N, Thomas R, O’Brien R, Vezina S, Longpre D,

Legault D, Milne M, Fafard J and Trottier B. P1-S2.52

Risk factors for STIs among MSM attending a

sexually transmitted disease clinic in Montreal,

Canada. Sex Trans Infect 2011; 87: A144.

Gravett RM, Westfall AO, Overton ET, Kudroff K, Muzny

CA and Eaton EF. Sexually transmitted infections and

sexual behaviours of men who have sex with men in

an American Deep South PrEP clinic. Int J STD AIDS

; 31(2): 127–135.

Lea T, Anning M, Wagner S, Owen L, Howes F and Holt

M. Barriers to accessing HIV and sexual health

services among gay men in Tasmania, Australia, J

Gay Lesbian Soc Serv 2019; 31: 153-165.

Rispel LC, Metcalf CA, Cloete A, Moorman J and Reddy

V. You become afraid to tell them that you are gay:

health service utilization by men who have sex with

men in South African cities. J Public Health Policy

; 32(Suppl 1): S137–S151.

Lane T, Mogale T, Struthers H, McIntyre J and Kegeles

SM. They see you as a different thing: the experiences

of men who have sex with men with healthcare

workers in South African township communities. Sex

Transm Infect 2008; 84(6): 430–433.

Ayala G. HIV treatment cascades that leak: correlates of

drop-off from the HIV care continuum among men

who have with men worldwide. J AIDS Clin Res 2014; 5: 2.


Trang K, Ly AT, Lam LX, Brown CA, To MQ, Sullivan

PS, Worthman CM, Giang LM and Jovanovic T.

Mental health in HIV prevention and care: a

qualitative study of challenges and facilitators to

integration in Vietnam. Soc Sci Med 2021; 279:

Batist E, Brown B, Scheibe A, Baral SD and Bekker LG.

Outcomes of a community-based HIV-prevention

pilot programme for township men who have sex with

men in Cape Town, South Africa. J Int AIDS Soc

; 16(Suppl 3): 18754.

Delany-Moretlwe S, Cowan FM, Busza J, Bolton-Moore

C, Kelley K and Fairlie L. Providing comprehensive

health services for young key populations: needs,

barriers and gaps. J Int AIDS Soc 2015; 18(2 Suppl

: 19833.

Wanyenze RK, Musinguzi G, Matovu JK, Kiguli J,

Nuwaha F, Mujisha G, Musinguzi J, Arinaitwe J and

Wagner GJ. “If you tell people that you had sex with

a fellow man, it is hard to be helped and treated":

barriers and opportunities for increasing access to HIV

services among men who have sex with men in

Uganda. PLoS One 2016; 11(1): e0147714.

Fay H, Baral SD, Trapence G, Motimedi F, Umar E, Iipinge S,

Dausab F, Wirtz A and Beyrer C. Stigma, health care

access, and HIV knowledge among men who have sex

with men in Malawi, Namibia, and Botswana. AIDS

Behav 2011; 15(6): 1088-97.


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