Post-treatment time to symptom resolution and associated factors in a cohort of Ugandan men with urethral discharge syndrome.

Abstract

Introduction: Ugandan men with urethral discharge syndrome (UDS) have high burdens of curable sexually transmitted infections (STIs) and HIV. STI complaints are treated syndromically, but post-treatment symptom resolution (SR) data are lacking in this group. This study estimated the time from treatment to symptom resolution (TTR) and examined associations with sociodemographic and behavioral factors and TTR.

Methods: 250 men with UDS were recruited at health centers in Kampala, Uganda. Participants underwent point-of-care testing for HIV/syphilis, and urogenital samples were retrospectively analyzed for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplamsa genitalium (MG), and Trichomonas vaginalis (TV) using Aptima nucleic acid amplification tests (Hologic Inc., Marlborough, MA, USA). Socio-behavioral data were collected by questionnaire. Participants received follow-up calls at 14-, and 21-days post-enrollment to assess SR, antibiotic adherence, and sexual behaviors. Differences between participants by SR at day 14 were determined by Fisher Exact test, Wilcoxon rank-sum test, Chi-squared test, and Welch's t-test as appropriate. Univariable and multivariable accelerated failure time (AFT) models were used to identify associations between participant factors and TTR.

Results: Of 239 (95.6%) participants who completed day 14 follow-up surveys, 37 (16%) did not have SR by 14-days post-enrollment and treatment initiation. Median (IQR) TTR was 4.0 (3.0,6.0) days. Delayed TTR was associated with previous episodes of UDS in the prior six months (2.0 vs. 1.4, p = 0.010) and negative tests for CT/NG/MG/TV (35% vs. 15%, p = 0.004). These relationships held true when controlling for potential confounders including prior antimicrobial use, possible reinfection following sexual exposures post-enrollment, treatment non-adherence, HIV status, and other behaviors associated with increased vulnerabilities to STIs.

Conclusion: Delayed TTR was associated with prior UDS episodes. Negative tests for common curable STIs were associated with delayed TTR suggesting the possible role of other infectious or non-infectious etiologies. The underlying mechanisms of delayed SR, e.g., reinfection, treatment failure, or dysregulated mucosal immunity, warrant further exploration.