Urethritis/Cervicitis Pathogen Prevalence and Associated Risk Factors Among Asymptomatic HIV-Infected Patients in South Africa

Lewis, David A.; Chirwa, Tobias; Msimang, Veerle; Radebe, F; Kamb, Mary L.; Firnhaber, Cynthia

doi:10.1097/olq.0b013e31824cbecc

Cited by 34 publications

(37 citation statements)

References 14 publications

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“…Because syndromic management relies on self-reported symptoms and clinical examination for visible signs, it is often unsuccessful at detecting asymptomatic infections. Fortunately, this study identified a low number of asymptomatic infections and none was primarily gonococcal or chlamydial infection, as usually reported (7). …”

Section: Discussionsupporting

confidence: 63%

Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya

et al. 2015

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Background Control of genital infections remains challenging in most regions. Despite advocacy by the World Health Organization (WHO) for syndromic case management, there are limited data on the syndromic approach, especially in HIV care settings. This study compared the syndromic approach against laboratory diagnosis among women in HIV care in Kenya. Methods A mobile team visited 39 large HIV care programs in Kenya and enrolled participants using population-proportionate sampling. Participants provided behavioral and clinical data with genital and blood specimens for lab testing. Results Among 1,063 women, 68.4% had been on antiretroviral therapy >1 year; 58.9% were using cotrimoxazole prophylaxis; 51 % had CD4+T-lymphocytes < 350 cells/mL. Most women (63.1%) reported at least one genital symptom. Clinical signs were found in 63% of women; and 30.8% had an etiological diagnosis. Bacterial vaginosis (17.4%), vaginal candidiasis (10.6%) and trichomoniasis (10.5%) were the most common diagnoses. Using laboratory diagnoses as gold standard, sensitivity and positive predictive value of the syndromic diagnosis for vaginal discharge were 47.6% and 52.7%, respectively, indicating a substantial amount of overtreatment. A systematic physical examination increased by 9.3% the positive predictive value for genital ulcer disease. Conclusions Women attending HIV care programs in Kenya have high rates of vaginal infections. Syndromic diagnosis was a poor predictor of those infections.

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Section: Discussionsupporting

confidence: 63%

Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya

et al. 2015

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“…One possible explanation for this gender difference may be that women are more likely to receive care in community or Provincial clinics that were not captured in our data. The difference is more likely due to high rates of asymptomatic STIs among women [20] resulting in a higher prevalence of clinic visits among men. We also found that younger patients were more likely to have STI, a finding that is consistent with the broader pattern of STI outside of people living with HIV [21].…”

Section: Discussionmentioning

confidence: 99%

High burden of STIs among HIV-infected adults prior to initiation of ART in South Africa: a retrospective cohort study

et al. 2014

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Objectives To assess the burden of STIs among HIV-positive South Africans in the period prior to ART initiation compared to the period once on ART. Methods We linked the clinic records of 1,465 patients currently on ART to the electronic database which records all visits to City clinics. We used a mixed effects Poisson model to assess the relative rates of occurrence of treatment seeking for an STI in the periods prior to initiation of ART and while on ART. Results We accumulated 4,214 person-years of follow-up, divided nearly equally between the pre-ART and on ART periods. The rate of treatment seeking for new STIs was 5.50 (95% CI 5.43–5.78) per 100 person-years, and individuals had on average a seven-fold higher rate of seeking treatment for STIs in the period prior to initiating ART (9.57 per 100 person-years) compared to the period once on ART (5.5 per 100 person-years) (adjusted rate ratio [RR] 7.01, 95% CI 4.64–10.59). Being male (RR 1.73, 95% CI 1.18–2.55) or younger (

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“…Our findings are consistent with several other studies which also found higher percentage of asymptomatic STIs in HIV positive individuals. [5][6][7][8] Thus the strategy of syndromic management works well in the HIV negative individuals where a very small percentage of patients who are actually infected but asymptomatic are missed. However in case of the HIV positive individuals the percentage of asymptomatic STIs is quite high and in this group the approach of syndromic management misses out large number of HIV positive asymptomatic patients who are actually infected with RTIs/STIs and remain untreated and are responsible for silently transmitting these infections in the community.…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic reproductive tract infections/sexually transmitted infections among HIV positive women

Bhattar

Rawat

Tripathi

et al. 2015

Indian Journal of Medical Microbiology

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This study aims to highlight the importance of screening all HIV positive women for various reproductive tract infections/sexually transmitted infections (RTIs/STIs) irrespective of symptoms and to determine its occurrence in asymptomatic HIV positive women. Relevant specimens were collected for diagnosis of various RTIs/STIs. STIs were diagnosed in nearly one-third of the HIV positive asymptomatic patients which is quite high. The national strategy for STIs/RTIs control misses out large number of asymptomatic RTIs/STIs in HIV positive women which is responsible for silently transmitting these infections in the community. So this strategy should be modified to include screening of all HIV positives women irrespective of symptoms of STIs/RTIs.

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Urethritis/Cervicitis Pathogen Prevalence and Associated Risk Factors Among Asymptomatic HIV-Infected Patients in South Africa

Abstract: Asymptomatic urethritis/cervicitis pathogens were highly prevalent in this population. Few urethritis/cervicitis pathogen-associated patient characteristics were identified, emphasizing the need for affordable STI diagnostics to screen HIV-infected patients.

Cited by 34 publications

References 14 publications

Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya

Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya

High burden of STIs among HIV-infected adults prior to initiation of ART in South Africa: a retrospective cohort study

Asymptomatic reproductive tract infections/sexually transmitted infections among HIV positive women

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