生殖道无症状感染负担高，破坏了南非青少年和青年人群体的综合征管理方法：对艾滋病毒预防工作的影响。
A high burden of asymptomatic genital tract infections undermines the syndromic management approach among adolescents and young adults in South Africa: implications for HIV prevention efforts.
机构信息
Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, B.C. V5A 1S6, Canada.
Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
BMC Infect Dis. 2018 Oct 3;18(1):499. doi: 10.1186/s12879-018-3380-6.
BACKGROUND
Youth in southern Africa, particularly adolescent girls and young women, are a key population for HIV prevention interventions. Untreated genital tract infections (GTIs) increase both HIV transmission and acquisition risks. South African GTI treatment guidelines employ syndromic management, which relies on individuals to report GTI signs and symptoms. Syndromic management may, however, underestimate cases, particularly among youth. We compared genital tract infection (GTI) prevalence by symptom-based and laboratory assessment among sexually-experienced youth in South Africa, overall and stratified by sex.
METHODS
Interviewer-administered surveys assessed socio-demographics, behaviors, and GTI symptoms among 352 youth (16-24 yrs., HIV-negative or unknown HIV status at enrollment) enrolled in community-based cohorts in Durban and Soweto (2014-2016). Laboratory tests assessed HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV) infections and, among females, bacterial vaginosis (BV) and Candida species. Youth with genital ulcers were tested for HSV-2 and syphilis. We assessed sensitivity (and specificity) of symptom-based reporting in identifying laboratory-confirmed GTIs.
RESULTS
At baseline, 16.2% of females (32/198) and < 1% (1/154) of males reported ≥1 GTI symptom. However, laboratory tests identified ≥1 GTI in 70.2% and 10.4%, respectively. Female CT prevalence was 18.2%, NG 7.1%, MG 9.6%, TV 8.1%, and 5.1% were newly diagnosed with HIV. BV prevalence was 53.0% and candidiasis 9.6%. One female case of herpes was identified (0 syphilis). Male CT prevalence was 7.8%, NG 1.3%, MG 3.3%, TV < 1%, and 2.0% were newly diagnosed with HIV. Overall, 77.8% of females and 100% of males with laboratory-diagnosed GTIs reported no symptoms or were asymptomatic. Sensitivity (and specificity) of symptom-based reporting was 14% (97%) among females and 0% (99%) among males.
CONCLUSION
A high prevalence of asymptomatic GTIs and very poor sensitivity of symptom-based reporting undermines the applicability of syndromic GTI management, thus compromising GTI control and HIV prevention efforts among youth. Syndromic GTI management does not meet the sexual health needs of young people. Policy changes incorporating innovations in GTI diagnostic testing are needed to reduce GTIs and HIV-associated risks among youth.
背景
在南部非洲，青年群体，尤其是少女和年轻妇女，是艾滋病毒预防干预措施的重点人群。未经治疗的生殖道感染（GTI）会增加艾滋病毒传播和感染的风险。南非 GTI 治疗指南采用综合征管理，依赖于个人报告 GTI 体征和症状。然而，综合征管理可能会低估病例，尤其是在青年群体中。我们比较了南非有性经验的青年中基于症状和实验室评估的生殖道感染（GTI）患病率，总体上以及按性别分层。
方法
在 2014 年至 2016 年期间，在德班和索韦托的社区队列中，对 352 名（16-24 岁，入组时 HIV 阴性或 HIV 状况未知）有性经验的青年进行了访谈者管理的调查，以评估社会人口统计学、行为和 GTI 症状。实验室检测评估了 HIV、沙眼衣原体（CT）、淋病奈瑟菌（NG）、生殖支原体（MG）、阴道毛滴虫（TV）感染，以及女性中的细菌性阴道病（BV）和念珠菌属。有生殖器溃疡的青年接受了单纯疱疹病毒 2 型和梅毒检测。我们评估了基于症状的报告在识别实验室确诊的 GTI 方面的敏感性（和特异性）。
结果
在基线时，16.2%的女性（198 名中的 32 名）和<1%的男性（154 名中的 1 名）报告了≥1 种 GTI 症状。然而，实验室检测分别发现了 70.2%和 10.4%的 GTI。女性 CT 患病率为 18.2%，NG 为 7.1%，MG 为 9.6%，TV 为 8.1%，5.1%为新诊断的 HIV。BV 患病率为 53.0%，念珠菌病为 9.6%。发现了 1 例女性生殖器疱疹（无梅毒）。男性 CT 患病率为 7.8%，NG 为 1.3%，MG 为 3.3%，TV <1%，2.0%为新诊断的 HIV。总体而言，77.8%的女性和 100%的男性有实验室诊断的 GTI 报告无症状或无症状。基于症状的报告的敏感性（和特异性）为 14%（97%）的女性和 0%（99%）的男性。
结论
无症状 GTI 的高患病率和基于症状的报告极低的敏感性，削弱了综合征管理在 GTI 方面的适用性，从而影响了青年群体的 GTI 控制和艾滋病毒预防工作。综合征管理不能满足年轻人的性健康需求。需要政策变革，纳入 GTI 诊断检测方面的创新，以减少青年群体中的 GTI 和艾滋病毒相关风险。
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