Epidemiology of ano-rectal STIs in Asia. Montreux, 2008

Transcription

1 Epidemiology of ano-rectal STIs in Asia Graham Neilsen Montreux, 28

2 Acknowledgments National partners Philippe Girault, FHI, Thailand Dimitri Prybilski, FHI, Thailand Elizabeth Pisani, FHI, Indonesia Guy Morineau, FHI, Indonesia Steve Mills, FHI, Vietnam Teodi Wi, FHI India Frits van Griensven, CDC/TUC, Thailand Sarah Hawkes, LSHTM, UK Angkana Charoenwatanachokchai, MOPH, Thailand Krysia Lindan, CDC

3 Outline 1. Basic issues 2. Syndromic management and anorectal infections 3. Prevalence of ano-rectal STIs 4. MSM and TGs epidemiology, clinical guidelines 5. Summary

4 Ano-rectal STIs: Issues High prevalence of asymptomatic infections High prevalence of ano-rectal symptoms (e.g., burning, itch, bleeding and discharge) Poor correlation between symptoms and STIs Incomplete history taking and lack of anorectal examination (poor training, attitudes, anal sex and women) Lack of testing for GC and CT Some conditions already covered by existing guidelines (e.g., GUD)

5 Rectal gonorrhea and chlamydia prevalence, MSM in Asia, Phnom Penh 2 Dili MSM Kathmandu 24 MSW Pakistan TGs 25 Kathmandu 24 MSM 18 1 Bangkok Manila 25 1 Cambodia Hanoi 26 7 HCMC Mumbai, Pakistan TGs 27 Re GC Re CT

6 STI prevalence among MSM in Cambodia, Syphilis Urethral Gonorrhea Rectal Gonorrhea Urethral Chlamydia Rectal Chlamydia 1 HIV 14.4 Phnom Penh (n=26)

7 STI prevalence among MSM in East Timor, Syphilis Urethral Gonorrhea Rectal Gonorrhea Urethral Chlamydia Rectal Chlamydia HSV-2 HIV MSM (n=1; rectal swabs n=87)

8 STI prevalence among MSM in Nepal, Syphilis (active) TPHA + Urethral Gonorrhea Rectal Gonorrhea Urethral Chlamydia Rectal Chlamydia HSV-2 HIV MSW (n=83) MSM (n=275)

9 STI prevalence among MSM in the Philippines, Syphilis Urethral Gonorrhea Rectal Gonorrhea Urethral Chlamydia Rectal Chlamydia HIV Baguio (n=26) Manila (n=26)

10 STI prevalence among MSWs and TGs, Pakistan, Karachi MSW (n=41) Karachi TG (n=197) Lahore MSW (n=4) Lahore TG (n=198) Syphilis Urethral Gonorrhea Rectal Gonorrhea Urethral Chlamydia Rectal Chlamydia HIV

11 STI prevalence among MSM practicing receptive anal sex, Bangkok, Anal Warts Urethral Gonorrhea Rectal Gonorrhea Urethral Chlamydia Rectal Chlamydia 9.1 (n=77) Charoenwatanachokchai A, et al. Dis Control J 27;33(2):111-2.

12 STI prevalence among MSM, Cambodia, Syphilis Urethral Gonorrhea Rectal Gonorrhea Urethral Chlamydia Rectal Chlamydia HIV MSM TG Three sites: Phnom Penh (n=3); Battambang (n=124); and Siem Reap (n=124).

13 STI prevalence among MSM in Viet Nam, Ha Noi (n=397) HCMC (n=393) Syphilis Urethral Gonorrhea Rectal Gonorrhea Urethral Chlamydia Rectal Chlamydia Any STI

14 STI prevalence among MSM, Mumbai, 26-7 (n=215) Urethral Gonorrhea Rectal Gonorrhea Urethral Chlamydia Rectal Chlamydia Source: Megan McGuire, Institute for Global Health, Mumbai UCSF/CAPS study. An intervention for male STD patients in Mumbai, India; a randomized controlled trial. A collaboration between UCSF, Mumbai District AIDS Control Society, Sion LTMG Hospital and Medical School, and TATA Institute of Social Sciences; funded by NIH. [personal communication].

15 STI Prevalence among MSWs, Rawalpindi and Abbotabad, Pakistan, Bantha Khotki Khusra HIV HSV-2 Active syphilis Rectal GC.4 Rectal CT Urine GC Urine CT Source: Hawkes S et al. WHO STI Meeting, Geneva, 28.

16 MSM Clinical Guidelines Guidelines: Curriculum:

17 Summary Wide range of prevalence of rectal GC/CT implications for presumptive treatment Highest rates seen in transgenders No data on neovaginal STIs Very few data on other rectal STIs e.g., anal syphilis, LGV, anal warts and other HPV disease No data for women

18 Study Methods Study Phnom Penh 2 Dili 23 Kathmandu 24 Pakistan 25 Bangkok 25 Manila 25 Cambodia 25 Vietnam 26 Mumbai, 26-7 Pakistan 27 Lab method GC culture, GC, CT Amplicor GC, CT Amplicor GC, CT Amplicor GC, CT Amplicor GC culture, CT ELISA GC, CT Amplicor GC, CT, BD ProbeTec GC, CT Amplicor GC, CT Amplicor GC, CT Amplicor Subjects and specimen collection All All, self All, self All, clinician Rec. anal sex only All, clinician or self All, self All, clinician All, clinician All, clinician

19 Syphilis* prevalence, MSM in Asia 36.8 MSW 5.7 MSW After van Griensven - Sources: NCAP, 26, CREPHA, FHI, 25, NAP, 26.

20 Syphilis prevalence among MSM in Asia Thailand 6. 8 Bangkok Beijing, Cambodia Phnom Penh 2 Hangzhou Shiang Hai 24-5 Jiangsu 23 Jakarta TG Ho Chi Minh 2 2. MSW 1.1 MSM 5. Manila 25 After van Griensven. Sources: Girault, 24, FHI, 22, 24, 25; Pisani, 24; Jiang, 26; Lui, 26; van Griensven, 27; Ma, 27; Ruan, 27.

21 HIV prevalence among MSM in Asia MSW 15.3 MSM 17.6 TG 14.4 MSW 5.5 MSM 11.9 TG.5 MSW Phuket 25 Had Yai 25 Phnom Penh 2-5.8, 3.1, 3.1, 4.6, 5.8 MSM 1.5 MSM Beijing 21-6 Shiang Hai MSW Chiang Mai 25 Shenzen MSM Yangon 28.3 Hangzhou 24 MandalayMSM MSW Thailand Battambang TG Siam Reap 25 Bangkok 36.7 TG MSW Pattaya MSM TG MSM MSM MSW MSM Hanoi 26 Jakarta 22 Ho Chi Minh TG 3.6 MSW 2.5 MSM MSM 24-5 MSM 2-3 MSM 26-7 Van Griensven. Sources: NBC, 26; UNAIDS, 26b, 26b; FHI, 26a, 26b; Choi, 23; MAP, 25; van Griensven, 25; MMWR, 26; Ma, 26, NCHADS, 26.