P1-S1.32 UrogenitalChlamydia trachomatisis a hyperendemic disease in Paramaribo Suriname. Results from a multiethnic society
Authors: van der Helm J , Grunberg A , Speksnijder A , de Vries H , Sabajo L 
Published: July 2011

Background

Suriname is a multicultural society with many ethnic groups, such as Creoles and Maroons (both descendants from the African diaspora due to slave trade), Indian, Javanese, and Chinese (all descendants from labour immigrants), Caucasians (descendants from Dutch farmers) indigenous Amerindian people and Mixed race persons. The prevalence ofChlamydia trachomatis(Ct) among Surinamese living in the Netherlands visiting the Amsterdam STI clinic is high, up to 17%. However, due to lack of testing facilities the prevalence of Ct in Suriname is unknown. We aimed to estimate the prevalence and risk factors for Ct in two outpatient clinics in Paramaribo, Suriname, S.A.

Methods

Between March 2008 and February 2010 436 men and 292 women were included in a high risk STI clinic and 829 women were included in a low risk birth control outpatient clinic in Paramaribo, Suriname. Male urine samples and nurse collected vaginal swabs were obtained for nucleic acid amplification test (NAAT) (APTIMA Combo 2, Gen-Probe, San Diego, USA) testing in Amsterdam. Logistic regression analysis was used to identify risk factors for Ct infection.

Results

Ct prevalence was 23% for men and 20% for women at the high risk STI clinic and 10% for women at the low risk birth control clinic. The distribution of individuals included from each ethnic group is representative for the ethnic composition of the Surinamese population. One of the more striking outcomes was that a high Ct prevalence was found among Creoles (20%), Mixed race (17%) and Javanese (16%) individuals. Adjusted for age and test site, the Ct prevalence was significantly higher among Creole and Javanese individuals compared to Indian, OR 2.0 (95% CI 1.2 to 3.3) and 2.1 (95% CI 1.2 to 3.8) respectively (Abstract P1-S1.32 table 1). Young age (≤24 years) was significantly associated with Ct infection OR 3.1 (95% CI 2.1 to 4.7). Educational level was not associated with Ct infection.

Abstract P1-S1.32 Table 1

Univariate and multivariate logistic regression analyses of factors associated with Ct infection

NAAT positive (%)Univariate OR (95% CI)Multivariate adjusted OR (95% CI)*Gender Male100/436 (22.9)2.1 (1.6 to 2.8)– Female138/1120 (12.3)1–Test site STI clinic (high-risk)157/728 (21.6)2.5 (1.9 to 3.4)2.4 (1.8 to 3.4) Birth c. clinic (low-risk)81/828 (9.8)11Age (years) ≤24104/438 (23.7)3.5 (2.3 to 5.2)3.1 (2.1 to 4.7) 25–3496/664 (14.5)1.9 (1.3 to 2.8)1.9 (1.2 to 2.8) ≥3537/453 (8.2)11Ethnic group Indian23/291 (7.9)11 Creole93/459 (20.3)3.0 (1.8 to 4.8)2.0 (1.2 to 3.3) Javanese28/180 (15.6)2.1 (1.2 to 3.9)2.1 (1.2 to 3.8) Maroon35/261 (13.4)1.8 (1.0 to 3.1)1.1 (0.6 to 1.9) Mixed race50/292 (17.1)2.4 (1.4 to 4.1)1.5 (0.9 to 2.6) Indigenous Amerindian3/25 (12.0)1.6 (0.4 to 5.7)1.0 (0.3 to 3.8) Chinese0/14 (0)00 Caucasian4/19 (21.1)3.1 (0.9 to 10.1)1.7 (0.5 to 5.6)*

ORs in the multivariate model are adjusted for all factors for which adjusted ORs are shown.

Conclusion

This is the first report on Ct epidemiology in Suriname. With a prevalence of 10% in the low risk birth control clinic population and 23% in the high risk STI clinic, the situation is alarmingly high and testing facilities are urgently needed to minimise further spread and disease burden of Ct. Moreover, the Ct prevalence is not equally distributed among the various ethnic groups. Especially the Creole and Javanese Surinamese populations are disproportionally affected.