Background Laboratory infrastructure is limited in Uganda; syndromic case management is used to treat sexually transmitted infections (STI). Progress in addressing the HIV epidemic is threatened by uncontrolled STI transmission. We report on the prevalence of STI in Kampala, Uganda. Methods Demographic and behavioral data were captured by questionnaire. Penile-meatal swabs, urine and blood were collected from Ugandan men with urethral discharge syndrome (UDS) attending 6 clinical sites in Kampala Uganda. Genital samples were cultured for Neisseria gonorrhoeae (NG), and nucleic acid amplifications tests (NAATs) performed for NG, Chlamydia trachomatis (CT), and Mycoplasma genitalium (MG). HIV, and syphilis were diagnosed using point-of-care assays. Results Of 250 participants, mean age was 27.9 (16-59 years), 140 (56.0%) were â¤25 years, and 238 (95.2%) identified as heterosexual. 'Always' condom use was 1 (0.4%), and 154 (61.6%) reported transactional sex in the previous 6 months. In the 14 days prior to attendance, 100 (40%) reported antibiotic use, including ciprofloxacin, doxycycline, and penicillin (26 (25.7%), 31 (30.7%), and 13 (12.9%), respectively) despite >98% resistance in NG isolates. NAAT positivity was 166 (66.5%), 51 (20.4%), and 29 (11.6%) for NG, CT, and MG respectively. Of 50 (20%) participants with HIV; 2 (0.8%) were newly diagnosed. Syphilis serology was positive in 25 (10%), of these 20 (80%) were new diagnoses; RPR range 1:1 - 1:1024. Dual and triple NG, CT, MG co-infections were found in 33 (13.3%), 4 (1.6%) respectively. Conclusions This cross-sectional study demonstrates a very high prevalence of bacterial STI in men with UDS, presenting to clinical services in Kampala. In contrast, new HIV infections were relatively uncommon. Without POC testing, the vast majority of syphilis infections would have gone undiagnosed. Diagnosing STI in this population presents an ideal segue into HIV prevention services; the feasibility and efficacy of this approach requires further study..
