Huyveneers Laura E P, Maphanga Mathapelo, Umunnakwe Chijioke N, Bosman-de Boer Larissa, Moraba Robert S, Tempelman Hugo A, Wensing Annemarie M J, Hermans Lucas E
Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Ndlovu Research Centre, Elandsdoorn, Limpopo, South Africa.
Trop Med Int Health. 2023 Apr;28(4):335-342. doi: 10.1111/tmi.13864. Epub 2023 Mar 13.
Sexually transmitted infections (STIs), including syphilis, chlamydia, gonorrhoea and trichomoniasis, are of global public health concern. While STI incidence rates in sub-Saharan Africa are high, longitudinal data on incidence and recurrence of STIs are scarce, particularly in rural areas. We determined the incidence rates of curable STIs in HIV-negative women during 96 weeks in a rural South African setting.
We prospectively followed participants enrolled in a randomised controlled trial to evaluate the safety and efficacy of a dapivirine-containing vaginal ring for HIV prevention in Limpopo province, South Africa. Participants were included if they were female, aged 18-45, sexually active, not pregnant and HIV-negative. Twelve-weekly laboratory STI testing was performed during 96 weeks of follow-up. Treatment was provided based on vaginal discharge by physical examination or after a laboratory-confirmed STI.
A total of 119 women were included in the study. Prevalence of one or more STIs at baseline was 35.3%. Over 182 person-years at risk (PYAR), a total of 149 incident STIs were diagnosed in 75 (65.2%) women with incidence rates of 45.6 events/PYAR for chlamydia, 27.4 events/100 PYAR for gonorrhoea and 8.2 events/100 PYAR for trichomoniasis. Forty-four women developed ≥2 incident STIs. Risk factors for incident STI were in a relationship ≤3 years (adjusted hazard ratio [aHR]: 1.86; 95% confidece interval [CI]: 1.04-2.65) and having an STI at baseline (aHR: 1.66; 95% CI: 1.17-2.96). Sensitivity and specificity of vaginal discharge for laboratory-confirmed STI were 23.6% and 87.7%, respectively.
This study demonstrates high STI incidence in HIV-negative women in rural South Africa. Sensitivity of vaginal discharge was poor and STI recurrence rates were high, highlighting the shortcomings of syndromic management in the face of asymptomatic STIs in this setting.
性传播感染(STIs),包括梅毒、衣原体感染、淋病和滴虫病,是全球公共卫生关注的问题。虽然撒哈拉以南非洲地区的性传播感染发病率很高,但关于性传播感染发病率和复发情况的纵向数据却很匮乏,尤其是在农村地区。我们确定了南非农村地区HIV阴性女性在96周内可治愈性传播感染的发病率。
我们对参与一项随机对照试验的参与者进行前瞻性随访,以评估含达匹韦林的阴道环在南非林波波省预防HIV的安全性和有效性。纳入标准为女性,年龄在18 - 45岁之间,有性行为,未怀孕且HIV阴性。在96周的随访期间,每12周进行一次实验室性传播感染检测。根据体格检查发现的阴道分泌物情况或实验室确诊的性传播感染提供治疗。
共有119名女性纳入研究。基线时一种或多种性传播感染的患病率为35.3%。在超过182人年的风险期(PYAR)内,共诊断出149例新发的性传播感染,75名(65.2%)女性发病,衣原体感染发病率为45.6例/人年,淋病发病率为27.4例/100人年,滴虫病发病率为8.2例/100人年。44名女性发生了≥2次新发的性传播感染。新发性传播感染的危险因素为恋爱关系≤3年(调整后风险比[aHR]:1.86;95%置信区间[CI]:1.04 - 2.65)以及基线时患有性传播感染(aHR:1.66;95% CI:1.17 - 2.96)。实验室确诊性传播感染时,阴道分泌物的敏感性和特异性分别为23.6%和87.7%。
本研究表明南非农村地区HIV阴性女性的性传播感染发病率很高。阴道分泌物的敏感性较差且性传播感染复发率较高,凸显了在这种情况下面对无症状性传播感染时综合征管理的不足。