Etiological Surveillance of Vaginal Discharge Syndrome in South Africa: 2019 to 2020.
Journal
Sexually transmitted diseases
ISSN: 1537-4521
Titre abrégé: Sex Transm Dis
Pays: United States
ID NLM: 7705941
Informations de publication
Date de publication:
01 08 2022
01 08 2022
Historique:
pubmed:
14
5
2022
medline:
15
7
2022
entrez:
13
5
2022
Statut:
ppublish
Résumé
The syndromic management of vaginal discharge syndrome (VDS) is challenging because of the prevalence of mixed infection with sexually transmitted infection (STI) pathogens and non-STI causes, such as bacterial vaginosis and candidiasis (CA). We aimed to determine the relative prevalence of VDS etiologies in women presenting to sentinel primary health care clinics in South Africa. Secondary objectives were to ascertain the predictive value of speculum findings for the presence of STI pathogens and the proportion of women presenting with clinical features of CA who had identifiable yeast on vaginal smear microscopy. Consecutive, consenting women with complaints of abnormal vaginal discharge were enrolled between January 1, 2019, and December 31, 2020. Genital discharge swab and blood specimens were collected and transported to a central STI reference laboratory in Johannesburg. A total of 364 women were enrolled at 3 sentinel sites. Bacterial vaginosis was the most common cause of VDS (163 of 361 [45.2%]; 95% confidence interval [CI], 40.1%-50.3%); however, a significant proportion had STI coinfection (71 of 163 [43.6%]; 95% CI, 35.8%-51.5%). The predominant STI etiology was Chlamydia trachomatis (73 [20.2%]; 95% CI, 16.4%-24.7%). An abnormal speculum finding had poor predictive value for STIs, and Gram stain microscopy showed yeast in only 37.2% of vaginal smears from women with CA symptoms. Bacterial vaginosis is the predominant cause of VDS in South Africa; however, STI coinfection is common. Clinical findings are poorly predictive of STI etiologies or candidiasis; therefore, a rapid and accurate STI point-of-care test would be useful in optimizing VDS management.
Sections du résumé
BACKGROUND
The syndromic management of vaginal discharge syndrome (VDS) is challenging because of the prevalence of mixed infection with sexually transmitted infection (STI) pathogens and non-STI causes, such as bacterial vaginosis and candidiasis (CA). We aimed to determine the relative prevalence of VDS etiologies in women presenting to sentinel primary health care clinics in South Africa. Secondary objectives were to ascertain the predictive value of speculum findings for the presence of STI pathogens and the proportion of women presenting with clinical features of CA who had identifiable yeast on vaginal smear microscopy.
METHODS
Consecutive, consenting women with complaints of abnormal vaginal discharge were enrolled between January 1, 2019, and December 31, 2020. Genital discharge swab and blood specimens were collected and transported to a central STI reference laboratory in Johannesburg.
RESULTS
A total of 364 women were enrolled at 3 sentinel sites. Bacterial vaginosis was the most common cause of VDS (163 of 361 [45.2%]; 95% confidence interval [CI], 40.1%-50.3%); however, a significant proportion had STI coinfection (71 of 163 [43.6%]; 95% CI, 35.8%-51.5%). The predominant STI etiology was Chlamydia trachomatis (73 [20.2%]; 95% CI, 16.4%-24.7%). An abnormal speculum finding had poor predictive value for STIs, and Gram stain microscopy showed yeast in only 37.2% of vaginal smears from women with CA symptoms.
CONCLUSIONS
Bacterial vaginosis is the predominant cause of VDS in South Africa; however, STI coinfection is common. Clinical findings are poorly predictive of STI etiologies or candidiasis; therefore, a rapid and accurate STI point-of-care test would be useful in optimizing VDS management.
Identifiants
pubmed: 35551421
doi: 10.1097/OLQ.0000000000001646
pii: 00007435-202208000-00007
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
565-570Informations de copyright
Copyright © 2022 American Sexually Transmitted Diseases Association. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest and Source of Funding: All authors have no conflicts of interest to declare. Funding for this work was obtained from the operational cost center of the Centre for HIV & STI at the National Institute for Communicable Diseases, South Africa.
Références
Guidelines for the Management of Symptomatic Sexually Transmitted Infections. Geneva, Switzerland: World Health Organization, 2021. Licence: CC BY-NC-SA 3.0 IGO.
Kularatne R, Radebe F, Kufa-Chakezha T, et al. Sentinel Surveillance of Sexually Transmitted Infection Syndrome Aetiologies and HPV Genotypes Among Patients Attending Primary Healthcare Facilities in South Africa, April 2014–September 2015. Johannesburg, South Africa: National Institute for Communicable Diseases; Centre for HIV & STIs, 2017.
Sexually Transmitted Infections Management Guidelines. Pretoria, South Africa: National Department of Health, 2015.
Kufa T, Gumede L, Maseko DV, et al. The demographic and clinical profiles of women presenting with vaginal discharge syndrome at primary care facilities in South Africa: Associations with age and implications for management. S Afr Med J 2018; 108:876–880.
Primary Healthcare Standard Treatment Guideline and Essential Medicine List. 6th ed. Pretoria, Republic of South Africa: National Department of Health, 2018.
Hainer BL, Gibson MV. Vaginitis. Am Fam Physician 2011; 83:807–815.
Wi TE, Ndowa FJ, Ferreyra C, et al. Diagnosing sexually transmitted infections in resource-constrained settings: Challenges and ways forward. J Int AIDS Soc 2019; 22(Suppl 6):e25343.
Kularatne R. Aetiological Surveillance of Sexually Transmitted Infection Syndromes at Sentinel Sites: GERMS SA 2018. Johannesburg, South Africa: National Institute for Communicable Diseases, 2019. GERMS-SA Surveillance Review 2018.
Barnabas SL, Dabee S, Passmore JS, et al. Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV. Int J STD AIDS 2018; 29:531–539.
UNAIDS 2020, 2nd Edition. 2021. Available at: https://www.unaids.org/sites/default/files/media_asset/JC3032_AIDS_Data_book_2021_En.pdf .
Street RA, Reddy T, Ramjee G. The generational effect on age disparate partnerships and the risk for human immunodeficiency virus and sexually transmitted infections acquisition. Int J STD AIDS 2016; 27:746–752.
van der Eem L, Dubbink JH, Struthers HE, et al. Evaluation of syndromic management guidelines for treatment of sexually transmitted infections in South African women. Trop Med Int Health 2016; 21:1138–1146.
Desai VK, Kosambiya JK, Thakor HG, et al. Prevalence of sexually transmitted infections and performance of STI syndromes against aetiological diagnosis, in female sex workers of red light area in Surat, India. Sex Transm Infect 2003; 79:111–115.
Vallely LM, Toliman P, Ryan C, et al. Performance of syndromic management for the detection and treatment of genital Chlamydia trachomatis , Neisseria gonorrhoeae and Trichomonas vaginalis among women attending antenatal, well woman and sexual health clinics in Papua New Guinea: A cross-sectional study. BMJ Open 2017; 7:e018630.
Unemo M, Ballard R, Ison C, et al. Laboratory Diagnosis of Sexually Transmitted Infections, Including Human Immunodeficiency Virus. Geneva, Switzerland: World Health Organization, 2013. ISBN 978 92 4 150584 0.
West B, Morison L, Schim van der Loeff M, et al. Evaluation of a new rapid diagnostic kit (FemExam) for bacterial vaginosis in patients with vaginal discharge syndrome in The Gambia. Sex Transm Dis 2003; 30:483–489.
Hillier SL, Austin M, Macio I, et al. Diagnosis and treatment of vaginal discharge syndromes in community practice settings. Clin Infect Dis 2021; 72:1538–1543.
Garrett NJ, Osman F, Maharaj B, et al. Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries. PLoS One 2018; 13:e0196209.
Gaydos CA, Van Der Pol B, Jett-Goheen M, et al. Performance of the Cepheid CT/NG Xpert rapid PCR test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae . J Clin Microbiol 2013; 51:1666–1672.
Schwebke JR, Gaydos CA, Davis T, et al. Clinical evaluation of the Cepheid Xpert TV assay for detection of Trichomonas vaginalis with prospectively collected specimens from men and women. J Clin Microbiol 2018; 56:56(2).
Unemo M, Bradshaw CS, Hocking JS, et al. Sexually transmitted infections: Challenges ahead. Lancet Infect Dis 2017; 17:e235–e279.
Murtagh M. The Point-of-Care Diagnostic Landscape for Sexually Transmitted Infections (STIs). Geneva, Switzerland: World Health Organization, 2019.
Vickerman P, Watts C, Peeling RW, et al. Modelling the cost effectiveness of rapid point of care diagnostic tests for the control of HIV and other sexually transmitted infections among female sex workers. Sex Transm Infect 2006; 82:403–412.