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A high burden of asymptomatic genital tract infections undermines the syndromic management approach among adolescents and young adults in South Africa: implications for HIV prevention efforts.

ABSTRACT: BACKGROUND:Youth in southern Africa, particularly adolescent girls and young women, are a key population for HIV prevention interventions. Untreated genital tract infections (GTIs) increase both HIV transmission and acquisition risks. South African GTI treatment guidelines employ syndromic management, which relies on individuals to report GTI signs and symptoms. Syndromic management may, however, underestimate cases, particularly among youth. We compared genital tract infection (GTI) prevalence by symptom-based and laboratory assessment among sexually-experienced youth in South Africa, overall and stratified by sex. METHODS:Interviewer-administered surveys assessed socio-demographics, behaviors, and GTI symptoms among 352 youth (16-24 yrs., HIV-negative or unknown HIV status at enrollment) enrolled in community-based cohorts in Durban and Soweto (2014-2016). Laboratory tests assessed HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV) infections and, among females, bacterial vaginosis (BV) and Candida species. Youth with genital ulcers were tested for HSV-2 and syphilis. We assessed sensitivity (and specificity) of symptom-based reporting in identifying laboratory-confirmed GTIs. RESULTS:At baseline, 16.2% of females (32/198) and?

SUBMITTER: Kaida A

PROVIDER: S-EPMC6171143 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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A high burden of asymptomatic genital tract infections undermines the syndromic management approach among adolescents and young adults in South Africa: implications for HIV prevention efforts.

Kaida Angela A Dietrich Janan J JJ Laher Fatima F Beksinska Mags M Jaggernath Manjeetha M Bardsley Megan M Smith Patricia P Cotton Laura L Chitneni Pooja P Closson Kalysha K Lewis David A DA Smit Jenni A JA Ndung'u Thumbi T Brockman Mark M Gray Glenda G

BMC infectious diseases 20181003 1

<h4>Background</h4>Youth in southern Africa, particularly adolescent girls and young women, are a key population for HIV prevention interventions. Untreated genital tract infections (GTIs) increase both HIV transmission and acquisition risks. South African GTI treatment guidelines employ syndromic management, which relies on individuals to report GTI signs and symptoms. Syndromic management may, however, underestimate cases, particularly among youth. We compared genital tract infection (GTI) pre ...[more]

PMID: 30285705

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Project description:BackgroundInfertility is estimated to affect approximately 9-30% of reproductive-aged couples. Several conditions involving one or both partners may contribute to infertility. The aim of this study is to evaluate the role of asymptomatic genital tract infections in the outcome of In Vitro Fertilization (IVF) in couples with infertility.MethodsA total of 285 infertile couples were enrolled in the study. Vaginal/endocervical swabs and semen samples were collected and subjected to microbiological analysis. Spermiograms were carried out on semen specimens, and lactobacilli were quantified in vaginal swabs. Data were associated with IVF results and analysed by using non parametric tests and multivariate analysis.ResultsMicrobiological analysis showed that 46.3% of couples presented with an asymptomatic genital tract infection. Spermiogram results showed a significantly diminished motility of sperm cells in samples positive to microbiological testing compared to negative specimens. Enterococcus faecalis was the most prevalent species (11.6%) in positive semen samples and was found to negatively affect both sperm morphology (p = 0.026) and motility (p = 0.003). Analysis of genital swabs from females showed that the presence of E. faecalis (p<0.0001), Escherichia coli (p = 0.0123), Streptococcus agalactiae (p<0.0001), and Gardnerella vaginalis (p = 0.0003) was significantly associated to reduced levels of vaginal lactobacilli. Association of microbiological data with IVF outcome showed that 85.7% of IVF+ couples was microbiologically negative, while IVF was successful in just 7.5% of couples infected with E. faecalis and/or U. urealyticum and/or M. hominis (p = 0.02).ConclusionsThe results show the negative impact of E. faecalis on sperm quality and the association of definite bacterial pathogens with reduced levels of vaginal lactobacilli. The presence of E. faecalis and/or U. urealyticum and/or M. hominis in genital samples of infertile couples is predictive for a negative outcome of IVF.

Project description:IntroductionPreterm birth complications are the most common cause of death in children under 5 years. The presence of multiple microorganisms and genital tract inflammation could be the common mechanism driving early onset of labour. South Africa has high levels of preterm birth, genital tract infections and HIV infection among pregnant women. We plan to investigate associations between the presence of multiple lower genital tract microorganisms in pregnancy and gestational age at birth.Methods and analysisThis cohort study enrols around 600 pregnant women at one public healthcare facility in East London, South Africa. Eligible women are ≥18 years and at <27 weeks of gestation, confirmed by ultrasound. At enrolment and 30-34 weeks of pregnancy, participants receive on-site tests for Chlamydia trachomatis and Neisseria gonorrhoeae, with treatment if test results are positive. At these visits, additional vaginal specimens are taken for: PCR detection and quantification of Trichomonas vaginalis, Candida spp., Mycoplasma genitalium, M. hominis, Ureaplasma urealyticum and U. parvum; microscopy and Nugent scoring; and for 16S ribosomal RNA gene sequencing and quantification. Pregnancy outcomes are collected from a postnatal visit and birth registers. The primary outcome is gestational age at birth. Statistical analyses will explore associations between specific microorganisms and gestational age at birth. To explore the association with the quantity of microorganisms, we will construct an index of microorganism load and use mixed-effects regression models and classification and regression tree analysis to examine which combinations of microorganisms contribute to earlier gestational age at birth.Ethics and disseminationThis protocol has approvals from the University of Cape Town Research Ethics Committee and the Canton of Bern Ethics Committee. Results from this study will be uploaded to preprint servers, submitted to open access peer-reviewed journals and presented at regional and international conferences.Trial registration numberNCT06131749; Pre-results.

Project description:BackgroundThere are inconsistent reports on the prevalence of oral conditions and their associated factors among adolescents living with HIV (ALHIV). The current inconsistencies may hinder the development of clear guidelines on the prevention and treatment of oral conditions among ALHIV. This study provides an update on oral conditions and their associated factors in a cohort of South African ALHIV and receiving routine HIV treatment services at a Johannesburg HIV wellness clinic.MethodsDecayed Teeth (DT), Decayed Missing and Filled Teeth (DMFT) and Oral HIV/AIDS Research Alliance case definitions were used for caries examination and reporting of the Oral Mucosal Lesions (OML) respectively. Data analyses were stratified by the study main outcomes; chi-squared tests were performed to determine the associations; and multiple logistic regressions were also used to identify associated factors after adjusting for other exposure variables. In addition to fitting logistic regressions, we explored the data for potential confounders and effect modifiers.ResultsA total of 407 ALHIV were assessed, of which 51.0% were females. The mean age of the ALHIV was 14.75 years (SD 2.43) while the median age of their parents was 43 years (IQR 37-48 years). Regardless of sex, age group and other socio-demographic characteristics, participants had high count of dental caries (DMFT>0). The overall prevalence of dental caries was 56.76% (n = 231) with mean DT score of 2.0 (SD 2.48) and mean DMFT score of 2.65 (SD 3.01). Dental caries prevalence (DT>0) was significantly associated with the HIV clinical markers. HIV RNA viral loads more than 1000 copies/ml and CD4 cell counts less than 200 count cells/mm3, increased the likelihood of having dental decay among ALHIV (p<0.05). ALHIV at WHO staging III, IV had higher caries prevalence ranging from 70% to 75% (p<0.05). The prevalence of dental caries was directly related to the presence of oral mucosal lesions (p<0.05). The prevalence of OML was 22%, with linear gingival erythema (13.8%) accounting for most of the OML. Multiple logistic regression modelling suggested that dental caries experience (DMFT>0), age category 13-15 years, WHO staging of IV and viral load of more than 1000 copies/ml significantly predicted the outcome of oral lesions as assessed using the OHARA case definitions (p<0.05). The odds of developing dental caries was also 1.5 times more among ALHIV who brush their teeth less frequently and those who reported more frequent eating of sugar sweetened diets (p<0.05).ConclusionsThere is high prevalence of dental caries and OML among ALHIV in Johannesburg. The reported prevalence was associated with high HIV RNA viral loads, shorter duration on antiretroviral treatment and high WHO staging of HIV disease on crude analysis. Additionally, caries experience contributed to the prevalence of OML. Our study acknowledges the protective effect of HIV treatment and positive oral health practices on the presence of oral conditions among ALHIV in Johannesburg.

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A high burden of asymptomatic genital tract infections undermines the syndromic management approach among adolescents and young adults in South Africa: implications for HIV prevention efforts.

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A high burden of asymptomatic genital tract infections undermines the syndromic management approach among adolescents and young adults in South Africa: implications for HIV prevention efforts.

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