(P111) TIME TO SYMPTOM RESOLUTION AND ASSOCIATED FACTORS IN UGANDAN MEN WITH URETHRAL DISCHARGE SYNDROME: IMPLICATIONS FOR STI MANAGEMENT

Background:
Sub-Saharan Africa shoulders a disproportionate burden of curable sexually transmitted infections (STIs) and HIV. The objectives of this study were 1) estimate time from treatment to symptom resolution (time to resolution (TTR)) in Ugandan men with urethral discharge syndrome (UDS), and 2) examine the association between sociodemographic and behavioral factors and TTR.

Methods:
250 men with UDS were recruited at health centers in Kampala, Uganda. Participants underwent HIV and syphilis testing at the clinics and urogenital samples were retrospectively analyzed for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplamsa genitalium (MG), Trichomonas vaginalis (TV) using Aptima NAATs (Hologic Inc., Marlborough, MA, USA). Demographic and behavioral data were collected. After enrollment, participants received follow-up calls at 7, 14, and 21 days, to assess symptom resolution, antibiotic adherence, and sexual behaviors. Differences between participants by symptom resolution at Day 14 were determined by Fisher Exact test, Wilcoxon rank-sum test, Chi-squared test, and Welch’s t-test as appropriate. Additionally, univariate and multivariate accelerated failure time (AFT) models were used to describe associations between participant factors and TTR as a continuous variable.

Results:
Of 239 (95.6%) participants who completed follow-up surveys, 37 (16%) did not have symptom resolution 14 days post-enrollment and treatment initiation. Delayed TTR was associated with previous episodes of UDS in the prior six months (2.0 vs. 1.4, p=0.010) and when CT/NG/MG/TV tests were negative (35% vs. 15%, p=0.004). These relationships held true when controlling for potential confounders including prior microbial use, possible reinfection following sex post-enrollment, treatment non-adherence, HIV status, and other behaviors associated with increased risk of STI.

Conclusion:
Delayed TTR was associated with prior UDS episodes, but the underlying mechanisms, e.g., reinfection or treatment failure, warrant further exploration. Intriguingly, negative tests for common STI pathogens were associated with delayed TTR, suggesting the possibility of other unidentified pathogens, false negative NAATs, or alternative pathologies.