Prevalence of Chlamydial, Gonococcal, and Syphilis Positivity by Anatomical Site and Sex Via Self-Collected Biospecimens Using At-Home Testing Kits Among a Large and Diverse Cohort of Men and Women Enrolled in the MACS/WIHS Combined Cohort Study (MWCCS) in the United States
Year: 2026
Type: article
Abstract: Introduction. Cisgender men who have sex with men (MSM), transgender women, cisgender women, and cisgender men who have sex with women only (MSW) have differential risk of acquiring Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC), the two most commonly reported bacterial sexually transmitted infections (STIs) in the United States (U.S.). Similarly, MSM and transgender women have a higher number of syphilis infections in the U.S. than other groups. The presence of any of these three STIs is a significant risk factor for HIV acquisition and transmission, unless taking antiretroviral medication for HIV prevention (PrEP) or treatment (ART). We sought to understanding the prevalence rates of STIs in various vulnerable populations by anatomical site, sex and gender, which will inform the development of targeted prevention interventions and guide future updates to national testing guidelines. Methods. Participants are enrolled in the MACS/WIHS Combined Cohort Study (MWCCS)—the longest-running observational study of both people living with HIV (PLWH) and sociodemographically similar people living without HIV (PLWOH) in the world—with a total of 13 clinical research sites across the U.S; participants (N = 5700) complete quantitative assessments related to a variety of behavioral and health related factors every 6 months. Regardless of whether or not they were sexually active or symptomatic/asymptomatic, all enrolled participants (i.e., cisgender MSM, transgender women, cisgender women, and cisgender MSW) were asked to complete surveillance testing for bacterial STIs (i.e., syphilis, CT and GC). In addition to urethral samples, cisgender MSM, transgender women, and cisgender MSW collected samples to test for extragenital pharyngeal and rectal CT and GC. Using at-home testing kits, participants self-collected biospecimens (i.e., dried blood spots (DBS)/ microtainer of blood, urine, and rectal and pharyngeal swabs) which were mailed to a central lab for nucleic acid amplification testing (NAAT for CT/GC) and syphilis testing using the reverse algorithm. STI results were linked to participants' HIV testing data and self-administered surveys on sociodemographics, sexual behaviors and psychosocial factors. Results. Among those tested, 24.6% of cisgender MSM, 25.8% of transgender women, 7.4% of cisgender women, and 14.6% cisgender MSW tested positive for at least one STI. Multiple STIs/anatomic sites were detected in 3.9% of participants, with the highest prevalence among transgender women (9.7%). Current/past syphilis prevalence was 11.2% across all participants, with cisgender MSM (19.7%) and transgender women (19.4%) having a higher prevalence than cisgender women (6.4%) and cisgender MSW (12.6%). Regarding CT, 2.1% of the participants tested were positive at one anatomical site. Among those who had extragenital testing, rectal CT was the most prevalent (3.2%), including 3.4% among cisgender MSM, 8.9% among transgender women, and 0.9% among cisgender MSW. For GC, 1.4% of participants tested positive at one site. Among those who tested for extragenital STIs, rectal GC was the most common site, with a prevalence of 2.2%, including 2.3% for cisgender MSM, 4.3% for transgender women, and 1.4% among MSW. Overall, 7.1% of participants tested positive for CT or GC at one or more anatomical sites. Finally, PLWH had a significantly higher prevalence of syphilis (13.74%) compared to PLWOH (6.11%) (p<0.001). Conclusion. There is a high prevalence of bacterial STIs among participants in the MWCCS. Selfcollection of DBS/microtainer of blood, urine, and rectal and pharyngeal swabs provided a useful, costeffective option for screening participants outside of the traditional clinical setting. Given the possible asymptomatic nature of all three STIs, regular testing and education can be key to detection and treatment. Culturally appropriate and locally-derived community outreach and engagement can be highly effective in reducing stigma around HIV and STIs and help reduce barriers to testing and treatment.
DOI: 10.17615/wpzt-g064
Authors: Palella, Frank J., Qian, Yuhang, Sharma, Anjali, Visconti, Adam J., Kempf, Mirjam-Colette, Tian, Jiahao, Friedman, M. Reuel, Konkle-Parker, Deborah, Ofotokun, Ighovwerha, Ho, Ken S., Dionne, Jodie A., Noori, Gilda, Augenbraun, Michael H., Jamieson, Beth D., D'Souza, Gypsyamber, Edmonds, Andrew, Mimiaga, Matthew J., Yonko, Elizabeth A., Plankey, Michael W., Tien, Phyllis C., Detels, Roger, Aziz, Najib, Chiu, Izzy, French, Audrey L., Alcaide, Maria L.
Institution: University of North Carolina at Chapel Hill
Language: English
Subfield: Microbiology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: green
Funders: Nuffield Department of Population Health, University of Oxford, Bundesministerium für Wirtschaft und Klimaschutz, Pfizer, Northwestern University, Asahi Glass Foundation, North Carolina Agricultural Foundation, Japan Agency for Medical Research and Development, Swedish Cancer Foundation, UK Research and Innovation, Henry Royce Institute, Georgia Clinical and Translational Science Alliance, Kempe Foundation, Samco Foundation, Cancer Research UK, Department of Health and Social Care, Japan Society for the Promotion of Science London, University College London, European Commission, National Research Foundation, South African Medical Research Council, Department of Atomic Energy, Government of India, Deutsche Forschungsgemeinschaft, Agence Nationale de la Recherche, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, National Natural Science Foundation of China, Grantová Agentura České Republiky, China Postdoctoral Science Foundation, Fondation pour la Recherche Médicale, Natural Science Foundation of Guangdong Province, Korea Health Industry Development Institute, National Research Foundation of Korea, Knut och Alice Wallenbergs Stiftelse, Saneyoshi Scholarship Foundation, Vetenskapsrådet, Western University, Universiteit Stellenbosch, Ben-Gurion University of the Negev, Natural Science Foundation of Henan Province, Università degli Studi di Torino, Nanjing Medical University, Jeju National University Hospital, Amano Institute of Technology, National Institute of Science Education and Research, Chongqing Social Science Planning Fund, Universidade Tiradentes, Foreign, Commonwealth and Development Office, National Institutes of Health, University of California, San Francisco, Center for AIDS Research, University of Alabama at Birmingham, Medical Research Council, Engineering and Physical Sciences Research Council, Biotechnology and Biological Sciences Research Council, Japan Society for the Promotion of Science, Fundação para a Ciência e a Tecnologia, Japan Science and Technology Agency, National Key Research and Development Program of China, Einstein Centrum für Regenerartive Therapien, Charité-Universitätsmedizin Berlin, Project 333 of Jiangsu Province, Basic and Applied Basic Research Foundation of Guangdong Province, National Institute on Alcohol Abuse and Alcoholism, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Human Genome Research Institute, National Cancer Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Dental and Craniofacial Research, National Institute on Minority Health and Health Disparities, Center for AIDS Research, University of North Carolina at Chapel Hill, Clinical and Translational Science Institute, University of California, Los Angeles, Precursory Research for Embryonic Science and Technology, HORIZON EUROPE European Research Council, International Space Science Institute
Awards: G1034546755, G1296759572, Translational Biomedical Science Training Grant, G1913134163, G1972383081, Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), G2008237588, G311558797, G3869857964, G4044828089, G5147848267, G5660189159, G5863844756, Clinical and Translational Science Institute, G5900455136, G6396423216, University of Miami Developmental HIV/AIDS Mental Health Research Center (D-ARC), G6745172908, G6990385686, G7152846654, Institutional Career Development Core, G775892330, G7760075911, G7807729167, Johns Hopkins Institute for Clinical and Translational Research, G9000080293, G9000082816, University of Pittsburgh MACS/WIHS CCS, MACS/WIHS -CCS, SF Bay Area MACS/WIHS Combined Cohort Study, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies, Center for AIDS Research at Emory University, Northwestern CORE Clinical Research Site: Trans-omics for HIV/AIDS Research, Los Angeles CRS for the MACS/WIHS Combined Cohort Study, Data Analysis and Coordination Center for the MACS-WIHS Combined Cohort Study, MACS/WIHS Combined Cohort Study: Cook County Clinical Research Site (CC_CRS), The University of North Carolina Center for AIDS Research, MACS/WIHS Combined Cohort Study: Brooklyn Clinical Research Site (Bklyn CRS), Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS) - Baltimore/Wash DC Center, Atlanta MACS/WIHS Combined Cohort Study Clinical Research Site, UAB-MISS MACS/WIHS Combined Cohort Study, Miami Center for AIDS Research, UCLA Clinical and Translational Science Institute, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR)
OpenAlex ID: W7138948482