Dramatic Shift in the Etiology of Genital Ulcer Disease Among Patients Visiting a Sexually Transmitted Infections Clinic in Lilongwe, Malawi.
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 Nov 2023
01 Nov 2023
Historique:
pmc-release:
01
11
2024
medline:
23
10
2023
pubmed:
12
10
2023
entrez:
12
10
2023
Statut:
ppublish
Résumé
Genital ulcer diseases (GUDs) are a common syndrome associated with sexually transmitted infections. Genital ulcer diseases increase the risk of HIV transmission, necessitating appropriate diagnosis and treatment. We provide an updated GUD etiology assessment in Malawi to guide diagnostic development and treatment algorithms. We enrolled patients 18 years or older presenting with GUD at a sexually transmitted infection clinic in Lilongwe, Malawi, between May and October 2021. We purposively sampled by HIV status. Swabs of ulcers were tested for Treponema pallidum, herpes simplex virus (HSV)-1 and HSV-2, Haemophilus ducreyi, and Chlamydia trachomatis using polymerase chain reaction. Blood was collected for syphilis and HSV-2 serologies and acute HIV testing. Participants were treated per Malawi guidelines. Ulcer resolution (size reduced by >50%) was evaluated 14 days later. Fifty participants enrolled (30 without HIV, 2 with acute HIV infection, 18 with HIV seropositivity; 32 men, 18 women). Forty-six (92%) had an etiology identified. Syphilis was more common among those without HIV (22 of 30 [73%]) than participants with HIV (PWH; 8 of 20 [40%]; P = 0.04). Herpes simplex virus was more common among PWH (11 of 20 [55%]) than participants without (2 of 30 [7%]; P = 0.0002). One-fifth (9 of 50 [18%]) had H. ducreyi. Among those who returned for follow-up (n = 45), 9 (20%) had unresolved ulcers; persistent GUD was slightly more common in PWH (6 of 19 [32%]) than participants without (3 of 26 [12%]; P = 0.14). We observed a dramatic increase in syphilis ulcer proportion in a population whose GUDs were previously HSV predominant. Observed differences in etiology and resolution by HIV status could play an important role in the ongoing transmission and treatment evaluation of GUD.
Sections du résumé
BACKGROUND
BACKGROUND
Genital ulcer diseases (GUDs) are a common syndrome associated with sexually transmitted infections. Genital ulcer diseases increase the risk of HIV transmission, necessitating appropriate diagnosis and treatment. We provide an updated GUD etiology assessment in Malawi to guide diagnostic development and treatment algorithms.
METHODS
METHODS
We enrolled patients 18 years or older presenting with GUD at a sexually transmitted infection clinic in Lilongwe, Malawi, between May and October 2021. We purposively sampled by HIV status. Swabs of ulcers were tested for Treponema pallidum, herpes simplex virus (HSV)-1 and HSV-2, Haemophilus ducreyi, and Chlamydia trachomatis using polymerase chain reaction. Blood was collected for syphilis and HSV-2 serologies and acute HIV testing. Participants were treated per Malawi guidelines. Ulcer resolution (size reduced by >50%) was evaluated 14 days later.
RESULTS
RESULTS
Fifty participants enrolled (30 without HIV, 2 with acute HIV infection, 18 with HIV seropositivity; 32 men, 18 women). Forty-six (92%) had an etiology identified. Syphilis was more common among those without HIV (22 of 30 [73%]) than participants with HIV (PWH; 8 of 20 [40%]; P = 0.04). Herpes simplex virus was more common among PWH (11 of 20 [55%]) than participants without (2 of 30 [7%]; P = 0.0002). One-fifth (9 of 50 [18%]) had H. ducreyi. Among those who returned for follow-up (n = 45), 9 (20%) had unresolved ulcers; persistent GUD was slightly more common in PWH (6 of 19 [32%]) than participants without (3 of 26 [12%]; P = 0.14).
CONCLUSIONS
CONCLUSIONS
We observed a dramatic increase in syphilis ulcer proportion in a population whose GUDs were previously HSV predominant. Observed differences in etiology and resolution by HIV status could play an important role in the ongoing transmission and treatment evaluation of GUD.
Identifiants
pubmed: 37824787
doi: 10.1097/OLQ.0000000000001853
pii: 00007435-202311000-00010
pmc: PMC10575672
mid: NIHMS1919750
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
753-759Subventions
Organisme : FIC NIH HHS
ID : D43 TW010060
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI050410
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI007001
Pays : United States
Informations de copyright
Copyright © 2023 American Sexually Transmitted Diseases Association. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest and Sources of Funding: None declared.
Références
Malawi Med J. 2019 Jun;31(2):118-125
pubmed: 31452844
PLoS One. 2010 Apr 01;5(4):e9973
pubmed: 20376310
AIDS. 2018 Nov 13;32(17):2525-2531
pubmed: 30289810
Sex Transm Dis. 2022 Aug 1;49(8):571-575
pubmed: 35551170
J Infect Dis. 1995 Feb;171(2):451-5
pubmed: 7844388
J Acquir Immune Defic Syndr. 2016 Mar 1;71(3):272-80
pubmed: 26428231
Sex Transm Dis. 2021 Jun 1;48(6):e68-e72
pubmed: 32925596
Sex Transm Infect. 1999 Feb;75(1):3-17
pubmed: 10448335
Lancet Infect Dis. 2020 Feb;20(2):240-249
pubmed: 31753763
Sex Transm Dis. 2013 Dec;40(12):923-8
pubmed: 24220352
Int J STD AIDS. 2020 Mar;31(4):359-363
pubmed: 32075535
AIDS. 1992 Nov;6(11):1317-20
pubmed: 1361745
J Infect Dis. 1991 Feb;163(2):233-9
pubmed: 1988508
Sex Transm Dis. 2012 Oct;39(10):787-91
pubmed: 23001266
Clin Microbiol Infect. 2004 Jun;10(6):530-6
pubmed: 15191381
AIDS. 2007 Oct 18;21(16):2237-42
pubmed: 18090052
Front Microbiol. 2016 Apr 22;7:558
pubmed: 27148238
Sex Transm Dis. 2018 Jan;45(1):61-68
pubmed: 29240636
PLoS One. 2018 Apr 4;13(4):e0194125
pubmed: 29617372