Higher seroprevalence of Entamoeba histolytica than that of HIV-1 at a voluntary counselling and testing centre in Tokyo

Abstract

BackgroundAmebiasis, which is caused by Entamoeba histolytica, is a re-emerging public health issue owing to sexually transmitted infection (STI) in Japan. However, epidemiological data are quite limited. MethodologyTo reveal the relative prevalence of sexually transmitted E. histolytica infection to other STIs, we conducted a cross-sectional study at a voluntary counselling and testing (VCT) centre in Tokyo. Seroprevalence of E. histolytica was assessed according to positivity with an enzyme-linked immunosorbent assay for E. histolytica-specific IgG in serum samples collected from anonymous VCT clients. Principal FindingsAmong 2,083 samples, seropositivity for E. histolytica was 2.64%, which was higher than that for HIV-1 (0.34%, p < 0.001) and comparable to that for syphilis (rapid plasma reagin (RPR) 2.11%, p = 0.31). Positivity for Chlamydia trachomatis in urine by transcription-mediated amplification (TMA) was 4.59%. Seropositivity for E. histolytica was high among RPR-or Treponema pallidum hemagglutination (TPHA)-positive individuals and it was not different between clients with and without other STIs. Both seropositivity of E. histolytica and RPR were high among male clients. The seropositive rate for anti-E. histolytica antibody was positively correlated with age. TMA positivity for urine C. trachomatis was high among female clients and negatively correlated with age. Regression analysis identified that male sex, older age, and TPHA-positive results are independent risk factors of E. histolytica seropositivity. ConclusionsSeroprevalence of E. histolytica was 7.9 times higher than that of HIV-1 at a VCT centre in Tokyo, with a tendency to be higher among people at risk for syphilis infection. Author summaryAmebiasis caused by Entamoeba histolytica is an increasingly prevalent sexually transmitted infection (STI) in Japan; however, relative to other STIs, the prevalence of E. histolytica has not been fully assessed. We investigated the seropositivity of E. histolytica using serum samples from 2,083 clients of a voluntary counselling and testing centre in Tokyo. E. histolytica seroprevalence (2.64%) was 7.9 times higher than that of HIV-1 (0.31%) and the same as that of syphilis (rapid plasma reagin: 2.11%). Logistic regression analysis showed that E. histolytica seroprevalence tended to be higher among individuals who were male, older, and positive in Treponema pallidum hemagglutination. These results strongly suggest that public health interventions should be considered to control sexual transmission of E. histolytica infection, which is currently neglected in Japan.