TY - JOUR
T1 - Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV
AU - for the Women’s Initiative in Sexual Health (WISH) study team
AU - Barnabas, Shaun L.
AU - Dabee, Smritee
AU - Passmore, Jo Ann S.
AU - Jaspan, Heather B.
AU - Lewis, David A.
AU - Jaumdally, Shameem Z.
AU - Gamieldien, Hoyam
AU - Masson, Lindi
AU - Muller, Etienne
AU - Maseko, Venessa D.
AU - Mkhize, Nonhlanhla
AU - Mbulawa, Zizipho
AU - Williamson, Anna Lise
AU - Gray, Clive M.
AU - Hope, Thomas J.
AU - Chiodi, Francesca
AU - Dietrich, Janan
AU - Gray, Glenda
AU - Bekker, Linda Gail
N1 - Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by grants from the European and Developing Countries Clinical Trials Partnership (EDCTP) Strategic Primer grant (SP.2011.41304.038) and the South African Department of Science and Technology (DST/CON 0260/2012). SLB was supported by the HIV Vaccine Trials Network SHAPe Program, the Fogarty Foundation and the South African Medical Research Council (MRC). SD was supported by the National Research Foundation (NRF) of South Africa and the Poliomyelitis Research Foundation. This work (ALW) was partially based upon research supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation. The DTHF also recognizes the support from ViiV health care in their YouthShield program. Perinatal HIV Research Unit was supported through funding from the South African MRC.
Publisher Copyright:
© 2017, © The Author(s) 2017.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - 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.
AB - 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.
KW - Female
KW - adolescents
KW - bacterial vaginosis
KW - sexually transmitted infections
KW - syndromic management
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U2 - 10.1177/0956462417740487
DO - 10.1177/0956462417740487
M3 - Article
C2 - 29198180
AN - SCOPUS:85042632677
VL - 29
SP - 531
EP - 539
JO - International Journal of STD and AIDS
JF - International Journal of STD and AIDS
SN - 0956-4624
IS - 6
ER -