Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV

Abstract

Adolescents in Africa are at high risk for HIV infection, other sexually transmitted infections (STIs) and bacterial vaginosis (BV). Since behavior and burden of STIs/BV may influence HIV risk, behavioral risk factors and prevalence of STIs/BV were compared in HIV-seronegative adolescent females (n = 298; 16-22 years) from two South African communities (Soweto and Cape Town). STIs ( Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, herpes simplex virus (HSV)-1, HSV-2, Treponema pallidum, and Haemophilus ducreyi) were detected by multiplex polymerase chain reaction, human papillomavirus (HPV) by Roche Linear Array, and BV by Nugent scoring. Rates of BV (Nugent ≥7; 46.6%) and HPV (66.8%) were high in both communities. Prevalence of C. trachomatis and N. gonorrhoeae were >2-fold higher in Cape Town than Soweto (Chlamydia: 42% [62/149] versus 18% [26/148], p < 0.0001; gonorrhoea 11% [17/149] versus 5% [7/148], p = 0.05). Only 24% of adolescents with vaginal discharge-causing STIs or BV were symptomatic. In South African adolescents, clinical symptoms compatible with vaginal discharge syndrome had a sensitivity of 23% and specificity of 85% for the diagnosis of discharge-causing STI or BV. In a region with high HIV prevalence and incidence, >70% of young women with treatable conditions that could enhance HIV risk would have been missed because they lacked symptoms associated with syndromic management.

Inflammatory cytokine biomarkers of asymptomatic sexually transmitted infections and vaginal dysbiosis: a multicentre validation study

“…Of the women in the WISH study (Cape Town and Soweto, South Africa),15 206/286 (72%) had a discharge-causing STI ( C. trachomatis , N. gonorrhoeae , T. vaginalis , M. genitalium ) or vaginal dysbiosis (BV/intermediate microbiota). In all genital samples collected, despite being from distinct locations in the lower reproductive tract, elevated IL-1α and IL-1β and reduced IP-10 together were consistently predictive of an STI or dysbiosis (figure 1), correctly classifying 76%, 76% and 73% of women for LWS, MC and VS, respectively (table 1).…”

“…This study included sexually experienced HIV-negative young women, regardless of symptoms, from the WISH study in Soweto (n=139) and Cape Town (n=147), South Africa 15. Additionally, we conducted a secondary analysis of FEM-PrEP clinical trial data,16 17 which included 264 HIV-uninfected women (aged 18–35 years) from Bondo, Kenya (n=144) and Pretoria, South Africa (n=120).…”

“…In WISH, PCR was used to identify STIs ( C. trachomatis , N. gonorrhoeae , T. vaginalis , M. genitalium , herpes simplex virus (HSV) 1/2, Treponema pallidum and Haemophilus ducreyi ) in VS samples 15. LWS were collected for BV assessment by Nugent scoring.…”

“…While these results were encouraging, we sought to evaluate the utility of these biomarkers in the broader African community and in different genital sample types. In this study, we validated the cytokines in >500 women enrolled in two studies (Women’s Initiative in Sexual Health (WISH)15 and the FEM-PrEP clinical trial16) conducted in four different regions of sub-Saharan Africa, comparing their performance with clinical signs and/or symptoms of STIs and vaginal dysbiosis. In addition, we investigated biomarker performance across four genital sample types.…”

Geografiese ligging beïnvloed vaginale mikrobiese profiele in Suid-Afrikaanse vroue

“…Ons resultate stel voor dat MIV profi laktiese metodes wat die vaginale mikrobiota teiken die effek van geografi ese ligging in ag moet neem. uit lae inkomste, hoë bevolkingsdigtheidsgemeenskappe (Kaapstad en Johannesburg), as deel van die Women's Initiative in Sexual Health (WISH) studie (Barnabas et al, 2017).…”