High prevalence of bacterial sexually transmitted infections among Brazilian adolescents' men who have sex with men in Northeast Brazil


BACKGROUND: Bacterial sexually transmitted infections (b-STI) among adolescents' men who have sex with men (aMSM) has been a growing concern in the era of PrEP rollout. However, data on the prevalence of b-STI and sexual behaviors among aMSM are still scarce. We aimed to estimate b-STI prevalence and associated factors among aMSM in Salvador, Brazil.
METHODS: Baseline data from one of the sites (Salvador city) of the first demonstration PrEP cohort study among aMSM 15 to 19 years old ongoing in Brazil (PrEP1519). Eligible participants (177) were enrolled between March 2019-August 2020 answered a sociodemographic/sexual behavior questionnaire. Swabs samples were collected from pharyngeal, urethral and rectal sites to test for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) using qPCR. Positivity was defined by detection in at least one site. Serological rapid test was used for Treponema pallidum (TP) detection. The outcome variable was b-STI dichotomized in 'yes' (at least one infection) and 'no'. Adjusted prevalence ratio (aPR) using Poisson regression with robust variance and 95% confidence intervals (95%CI) were estimated.
RESULTS: The prevalence of b-STI were high among aMSM specifically NG (18.1%) and TP (11.0%) (Table 1). Factors associated with any b-STI were lower education (aPR=1.92, 95%CI: 1.22-3.01), receptive anal sex with casual partners (aPR=1.77, 95%CI: 1.14-2.77), drug use interfering with condom use (aPR=1.74, 95%CI: 1.07-2.83) and clinical suspicion of a b-STI (aPR=2.08, 95%CI: 1.30-3.34).

Table 1. Baseline prevalence of b-STI among aMSM. PrEP1519 study- Salvador site

Sexually Transmitted InfectionnPrevalence (%)
Neisseria gonorrhoeae3218.113.0-24.5
Chlamydia trachomatis63.41.5-7.4
Mycoplasma genitalium116.23.5-10.9
Treponema pallidum1911.07.1-16.7
Any b-STI4532.225.7-39.5

CONCLUSIONS: We observed worrisome rates of b-STIs among aMSM. A comprehensive approach for STI prevention is essential for aMSM, not only in terms of point of care protocols/screening tests but also service delivery that includes LGBT friendly environments, counselling, follow-up and linkage to health services.