Prevalence and risk factors for gonococcal infection in Reunion Island - 29/12/21

Doi : 10.1016/j.idnow.2021.12.003

A. Saïb ^a, N. Bouscaren ^b, B. Berçot ^c,^d, A. Duchateau ^e, G. Miltgen ^f, R. Rodet ^g, G. Wartel ^g, F. Andry ^a, S. Iacobelli ^h, A. Bertolotti ^a,^b,^⁎
^a CHU Réunion, service des maladies infectieuses – dermatologie, Saint-Pierre, Reunion
^b Inserm CIC1410, CHU Réunion, Saint-Pierre, Reunion
^c Département des agents infectieux, unité fonctionnelle de bactériologie, hôpital Saint-Louis, Assistance publique–Hôpitaux de Paris, Paris, France
^d Université Paris Diderot, UMR 1137, IAME, Sorbonne-Paris Cité, Paris, France
^e CHU Réunion, service de gynécologie, Saint-Pierre, Reunion
^f CHU Réunion, service de microbiologie, Saint-Denis, Reunion
^g CHU Réunion, service des maladies infectieuses, Saint-Denis, Reunion
^h CHU Réunion, service de néonatalogie, Saint-Pierre, Reunion

^⁎Corresponding author at: Service des maladies infectieuses – dermatologie, INSERM CIC 1410, CHU de la Réunion, Saint-Pierre, Reunion.Service des maladies infectieuses – dermatologie, INSERM CIC 1410, CHU de la RéunionSaint-PierreReunion

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Highlights

•	The overall prevalence of Neisseria gonorrhoeae (NG) in Reunion Island is close (2.8%) to that observed in other countries, but minors are especially at-risk (4.4%).
•	For all infection sites, the main risk factors were age under 18 (P=0.03), precarity (P=0.002), and history of sexually transmitted infections (P=0.006).
•	No NG strain was resistant to ceftriaxone.
•	The homosexual population was much smaller than in mainland France.
•	Prevention, screening, and treatment of sexually transmitted infections in minors in Reunion Island is essential.

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Abstract

Objective

To determine the prevalence and risk factors for gonococcal infection, and the resistance profile of Neisseria gonorrhoeae (NG) in Reunion Island.

Patients and methods

All patients who visited the four sexually transmitted infection (STI) clinics of Reunion Island between January 2017 and December 2018 were screened by multiplex polymerase chain reaction. Data on patient characteristics were collected using a self-administered questionnaire (reason for screening, marital status, risk-taking behaviors, place of birth, employment status, type of health care coverage, sexual orientation, number of sexual partners, occurrence of extra-marital relationships, history of STIs, and symptomatology. Precarity was defined as being unemployed and/or receiving universal health insurance).

Results

The prevalence of NG (n=4289) in the screened population was 2.8% (95% CI [2.3–3.3]). Minors were especially at-risk (4.4% (95% CI [2.6–7])) and especially girls (5.6% (95% CI [3.2–8.9])). The prevalence observed in the homosexual population was 4.0% [2.6–5.9]. Gonococcal infection was asymptomatic in 56 (69%) patients. For all infection sites, the main risk factors were male minors (P=0.019), individuals living in conditions of precarity (P=0.023), individuals co-infected with chlamydia (P<0.001) or syphilis (P<0.001), and individuals of foreign origin (P=0.006). No NG strain was resistant to ceftriaxone. Strains were resistant to penicillin G, ciprofloxacin, and azithromycin in 22% (20/91), 38% (35/91), and 1% (1/91) of cases, respectively.

Conclusion

The prevalence of NG in patients visiting STI clinics in Reunion Island is particularly high among minors. Prevention programs targeting this population should be reinforced and screening should be facilitated in school settings.

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Keywords : Neisseria gonorrhoeae, Prevalence, Reunion Island