Urethritis/cervicitis pathogen prevalence and associated risk factors among asymptomatic HIV-infected patients in South Africa.

Abstract

BACKGROUND:

To determine sexually transmitted infection (STI) prevalence, and patient characteristics associated with detection of urethritis/cervicitis pathogens, among HIV-infected individuals offered voluntary STI screening at a South African HIV treatment center.

METHODS:

Individuals, asymptomatic for genital discharge, were screened for Neisseria gonorrhoeae (NG), Chlamydia trachomatis, Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) infections (real-time polymerase chain reaction assay), for syphilis and herpes simplex type 2 (serologically), and for bacterial vaginosis and Candida (microscopy, women only). Patients' most recent CD4 and viral load results were recorded. Demographic, clinical, and behavioral data were collected by nurse-administered questionnaire.

RESULTS:

Compared with men (n = 551), women (n = 558) were younger (mean age, 35.0 vs. 37.9 years; P < 0.001), reported more STIs in the past year (65.5% vs. 56.5%; P = 0.002), had more urethritis/cervicitis pathogens detected (21.3% vs.16.4%, P = 0.035), and were less aware of their partner's HIV status (53.1% vs. 62.3%; P = 0.007). The overall prevalence of individual urethritis/cervicitis pathogens was TV (7.6%), MG (6.1%), NG (5.4%), and C. trachomatis (2.1%). Multivariate analysis highlighted 4 significant factors associated with the detection of specific urethritis/cervicitis pathogens, namely female gender (TV, adjusted odds ratio [aOR] 2.53, 95% confidence interval [CI]: 1.47-4.37), having a regular sexual partner in the past 3 months (NG, aOR 2.26, 95% CI: 1.01-5.08), suboptimal condom use with regular partners (TV, aOR 2.07, 95% CI: 1.25-3.42), and a history of genital warts in the past year (NG, 2.25, 95% CI: 1.26-4.03).

CONCLUSIONS:

Asymptomatic urethritis/cervicitis pathogens were highly prevalent in this population. Few urethritis/cervicitis pathogen-associated patient characteristics were identified, emphasizing the need for affordable STI diagnostics to screen HIV-infected patients.

• Authors: David A Lewis, Tobias F Chirwa, Veerle M Y Msimang, Frans M Radebe, Mary L Kamb, Cynthia S Firnhaber
• Journal: Sexually transmitted diseases (Sex Transm Dis) Vol. 39 Issue 7 Pg. 531-6 (Jul 2012) ISSN: 1537-4521 [Electronic] United States
• PMID: 22706215 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Topics

• AIDS-Related Opportunistic Infections (epidemiology, microbiology, parasitology, prevention & control)
• Adult
• Aged
• Algorithms
• CD4 Lymphocyte Count
• Chlamydia trachomatis (isolation & purification)
• Cross-Sectional Studies
• Female
• HIV Seropositivity
• Humans
• Male
• Mass Screening
• Middle Aged
• Mycoplasma genitalium (pathogenicity)
• Neisseria gonorrhoeae (isolation & purification)
• Polymerase Chain Reaction (methods)
• Prevalence
• Risk Factors
• Sexual Partners
• South Africa (epidemiology)
• Trichomonas vaginalis (isolation & purification)
• Urethritis (epidemiology, microbiology, prevention & control)
• Uterine Cervicitis (epidemiology, microbiology, prevention & control)
• Viral Load