Symptomatic Vaginal Discharge Is a Poor Predictor of Sexually Transmitted Infections and Genital Tract Inflammation in High-Risk Women in South Africa
| Autor: | Lise. Werner, Salim S. Abdool Karim, Katharina Ronacher, Cheryl Baxter, Anna Christina. Grobler, A. Willem Sturm, Nivashnee Naicker, Lindi Roberts, Koleka Mlisana, Francois van Loggerenberg, Gerjard. Walzl, Jo-Ann S. Passmore, Carolyn Williamson |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Vaginal discharge medicine.medical_specialty Population Sexually Transmitted Diseases HIV Infections urologic and male genital diseases Reproductive Tract Infections Asymptomatic Cohort Studies Major Articles and Brief Reports South Africa Prevalence medicine Humans Immunology and Allergy education Inflammation Gynecology education.field_of_study business.industry Obstetrics Incidence Incidence (epidemiology) Hazard ratio virus diseases Genitalia Female medicine.disease female genital diseases and pregnancy complications Vaginal Discharge Infectious Diseases Cohort HIV-1 Cytokines Female medicine.symptom Bacterial vaginosis business Follow-Up Studies Cohort study |
| Zdroj: | The Journal of Infectious Diseases. 206:6-14 |
| ISSN: | 1537-6613 0022-1899 |
| Popis: | Background. Diagnosis and treatment of sexually transmitted infections (STIs) is a public health priority, particularly in regions where the incidence of human immunodeficiency virus (HIV) infection is high. In most developing countries, STIs are managed syndromically. We assessed the adequacy of syndromic diagnosis of STIs, compared with laboratory diagnosis of STIs, and evaluated the association between STI diagnosis and the risk of HIV acquisition in a cohort of high-risk women. Methods. HIV-uninfected high-risk women (n = 242) were followed for 24 months. Symptoms of STIs were recorded, and laboratory diagnosis of common STI pathogens was conducted every 6 months. Forty-two cytokines were measured by Luminex in cervicovaginal lavage specimens at enrollment. Human immunodeficiency virus type 1 (HIV-1) infection was evaluated monthly. Results. Only 12.3% of women (25 of 204) who had a laboratory-diagnosed, discharge-causing STI had clinically evident discharge. Vaginal discharge was thus a poor predictor of laboratory-diagnosed STIs (sensitivity, 12.3%; specificity, 93.8%). Cervicovaginal cytokine concentrations did not differ between women with asymptomatic STIs and those with symptomatic STIs and were elevated in women with asymptomatic STIs, compared with women with no STIs or bacterial vaginosis. Although laboratory-diagnosed STIs were associated with increased risk of HIV infection (hazard ratio, 3.3 [95% confidence interval, 1.5–7.2)], clinical symptoms were not. Conclusions. Syndromic STI diagnosis dependent on vaginal discharge was poorly predictive of laboratory-diagnosed STI. Laboratory-diagnosed STIs were associated with increased susceptibility to HIV acquisition, while vaginal discharge was not. |
| Databáze: | OpenAIRE |
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