Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
Sex Transm Infect. 2021 Dec;97(8):555-565. doi: 10.1136/sextrans-2020-054740. Epub 2021 Feb 19.
STIs cause inflammation that is detrimental for both HIV risk and reproductive health. We assessed the impact of point-of-care (POC) STI testing, immediate treatment and expedited partner therapy (EPT) on genital tract cytokines among a cohort of young South African women.
HIV-negative women underwent POC testing for (CT), (NG) and (TV) by Xpert CT/NG and OSOM TV, and for bacterial vaginosis (BV) by microscopy. Women with STIs and/or BV received immediate treatment, EPT for STIs and retested after 6 and 12 weeks. Concentrations of 48 cytokines were measured in cervicovaginal fluid at each visit using multiplex ELISA technology. The impact of STI treatment on cytokine concentrations was assessed by multivariable linear mixed models and principal component analysis.
The study enrolled 251 women with median age of 23 years (IQR 21-27). The prevalence of CT, NG and TV were 14.3%, 4.4% and 4.0%, and 34.3% had BV. Women with STIs or BV at baseline (n=94) had significantly higher concentrations of pro-inflammatory cytokines (interleukin (IL)-1α, IL-1β, IL-6, tumour necrosis factor (TNF)-α, TNF-β, IL-18 and macrophage inflammatory factor (MIF)) and chemokines (IL-8, IL-16, macrophage inflammatory protein (MIP)-1α, IFN-α2, monokine induced by gamma interferon (MIG), monocyte chemoattractant protein (MCP)-3, regulated on activation normal T cell expressed and secreted and eotaxin) compared with women without (n=157). STI treatment was strongly associated with reduced concentrations of pro-inflammatory cytokines IL-6 (p=0.004), IL-1β (p=0.013), TNF-α (p=0.018) and chemokines MIG (p=0.008) and growth-related oncogene (GRO)-α (p=0.025). A lower Nugent score was associated with a reduction in pro-inflammatory cytokines IL-1α (p=0.003), TNF-related apoptosis-inducing ligand (p=0.004), MIF (p=0.010) and IL-18 (p<0.001), but an increase in chemokines MIG (p=0.020), GRO-α (p<0.001), IP-10 (p<0.001), MIP-1β (p=0.008) and MCP-1 (p=0.005). Principal component analysis showed differences in STI and BV-related inflammatory profiles, but that resolution restored a profile consistent with vaginal health.
A comprehensive STI intervention effectively reduced genital inflammation among young women, thereby improving vaginal health and potentially reducing HIV risk.
性传播感染会引起炎症，这对艾滋病毒风险和生殖健康都有不利影响。我们评估了即时护理点（POC）性传播感染检测、即时治疗和快速性伴侣治疗（EPT）对南非年轻女性生殖道细胞因子的影响。
HIV 阴性女性接受了 Xpert CT/NG 和 OSOM TV 检测的衣原体（CT）、淋病奈瑟菌（NG）和梅毒螺旋体（TV），以及显微镜检查细菌性阴道病（BV）。患有性传播感染和/或 BV 的女性接受即时治疗、EPT 治疗性传播感染，并在 6 周和 12 周后进行复查。采用多重酶联免疫吸附试验技术，在每次就诊时测量宫颈阴道分泌物中 48 种细胞因子的浓度。采用多变量线性混合模型和主成分分析评估性传播感染治疗对细胞因子浓度的影响。
该研究纳入了 251 名中位年龄为 23 岁（IQR 21-27）的女性。CT、NG 和 TV 的患病率分别为 14.3%、4.4%和 4.0%，34.3%的女性患有 BV。基线时患有性传播感染或 BV 的女性（n=94），其促炎细胞因子（白细胞介素（IL）-1α、IL-1β、IL-6、肿瘤坏死因子（TNF）-α、TNF-β、IL-18 和巨噬细胞炎性因子（MIF））和趋化因子（IL-8、IL-16、巨噬细胞炎性蛋白（MIP）-1α、IFN-α2、γ干扰素诱导的单核细胞趋化因子（MIG）、单核细胞趋化蛋白（MCP）-3、激活正常 T 细胞表达和分泌的调节因子和嗜酸性粒细胞趋化因子）浓度明显高于无上述疾病的女性（n=157）。性传播感染治疗与促炎细胞因子 IL-6（p=0.004）、IL-1β（p=0.013）、TNF-α（p=0.018）和趋化因子 MIG（p=0.008）和生长相关癌基因（GRO）-α（p=0.025）浓度降低密切相关。Nugent 评分降低与促炎细胞因子 IL-1α（p=0.003）、肿瘤坏死因子相关凋亡诱导配体（p=0.004）、MIF（p=0.010）和 IL-18（p<0.001）浓度降低，以及趋化因子 MIG（p=0.020）、GRO-α（p<0.001）、IP-10（p<0.001）、MIP-1β（p=0.008）和 MCP-1（p=0.005）浓度升高相关。主成分分析显示，性传播感染和 BV 相关的炎症谱存在差异，但得到解决后恢复了与阴道健康一致的炎症谱。
全面的性传播感染干预措施可有效降低年轻女性的生殖道炎症，从而改善阴道健康，降低艾滋病毒风险。
