Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV

doi:10.1177/0956462417740487

. 2018 May;29(6):531-539.

doi: 10.1177/0956462417740487. Epub 2017 Dec 4.

Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV

Shaun L Barnabas^{1

2}, Smritee Dabee¹, Jo-Ann S Passmore^{1

3

4}, Heather B Jaspan^{1

5}, David A Lewis^{6

7

8}, Shameem Z Jaumdally^{1

4}, Hoyam Gamieldien^{1

3}, Lindi Masson^{1

3}, Etienne Muller⁸, Venessa D Maseko⁸, Nonhlanhla Mkhize⁸, Zizipho Mbulawa^{1

3}, Anna-Lise Williamson^{1

3

9}, Clive M Gray^{1

3}, Thomas J Hope¹⁰, Francesca Chiodi¹¹, Janan Dietrich¹², Glenda Gray^{12

13}, Linda-Gail Bekker^{1

2}; Women’s Initiative in Sexual Health (WISH) study team

Affiliations

¹ 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
² 2 Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
³ 3 National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
⁴ 4 DST-NRF CAPRISA Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa.
⁵ 5 145793 Seattle Children's Research Institute , University of Washington, Seattle, WA, USA.
⁶ 6 Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia.
⁷ 7 Centre for Infectious Diseases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, Australia.
⁸ 8 Centre for HIV and STIs, 70687 National Institute for Communicable Disease , National Health Laboratory Service, Johannesburg, South Africa.
⁹ 9 SAMRC/UCT Gynaecological Cancer Research Centre Center for HIV and STIs, Cape Town, South Africa.
¹⁰ 10 Northwestern University, Chicago, USA.
¹¹ 11 Karolinska Institute, Stockholm, Sweden.
¹² 12 Perinatal HIV Research Unit, Faculty of Health Sciences, 196579 University of the Witwatersrand , Diepkloof, Johannesburg, South Africa.
¹³ 13 59097 South African Medical Research Council , Cape Town, South Africa.

PMID: 29198180
DOI: 10.1177/0956462417740487

Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV

Shaun L Barnabas et al. Int J STD AIDS. 2018 May.

. 2018 May;29(6):531-539.

doi: 10.1177/0956462417740487. Epub 2017 Dec 4.

Authors

Affiliations

¹ 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
² 2 Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
³ 3 National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
⁴ 4 DST-NRF CAPRISA Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa.
⁵ 5 145793 Seattle Children's Research Institute , University of Washington, Seattle, WA, USA.
⁶ 6 Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia.
⁷ 7 Centre for Infectious Diseases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, Australia.
⁸ 8 Centre for HIV and STIs, 70687 National Institute for Communicable Disease , National Health Laboratory Service, Johannesburg, South Africa.
⁹ 9 SAMRC/UCT Gynaecological Cancer Research Centre Center for HIV and STIs, Cape Town, South Africa.
¹⁰ 10 Northwestern University, Chicago, USA.
¹¹ 11 Karolinska Institute, Stockholm, Sweden.
¹² 12 Perinatal HIV Research Unit, Faculty of Health Sciences, 196579 University of the Witwatersrand , Diepkloof, Johannesburg, South Africa.
¹³ 13 59097 South African Medical Research Council , Cape Town, South Africa.

PMID: 29198180
DOI: 10.1177/0956462417740487

Abstract

Adolescents in Africa are at high risk for HIV infection, other sexually transmitted infections (STIs) and bacterial vaginosis (BV). Since behavior and burden of STIs/BV may influence HIV risk, behavioral risk factors and prevalence of STIs/BV were compared in HIV-seronegative adolescent females (n = 298; 16-22 years) from two South African communities (Soweto and Cape Town). STIs ( Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, herpes simplex virus (HSV)-1, HSV-2, Treponema pallidum, and Haemophilus ducreyi) were detected by multiplex polymerase chain reaction, human papillomavirus (HPV) by Roche Linear Array, and BV by Nugent scoring. Rates of BV (Nugent ≥7; 46.6%) and HPV (66.8%) were high in both communities. Prevalence of C. trachomatis and N. gonorrhoeae were >2-fold higher in Cape Town than Soweto (Chlamydia: 42% [62/149] versus 18% [26/148], p < 0.0001; gonorrhoea 11% [17/149] versus 5% [7/148], p = 0.05). Only 24% of adolescents with vaginal discharge-causing STIs or BV were symptomatic. In South African adolescents, clinical symptoms compatible with vaginal discharge syndrome had a sensitivity of 23% and specificity of 85% for the diagnosis of discharge-causing STI or BV. In a region with high HIV prevalence and incidence, >70% of young women with treatable conditions that could enhance HIV risk would have been missed because they lacked symptoms associated with syndromic management.

Keywords: Female; adolescents; bacterial vaginosis; sexually transmitted infections; syndromic management.

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Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV

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Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV

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