Symptomatic vaginal discharge is a poor predictor of sexually transmitted infections and genital tract inflammation in high-risk women in South Africa

Journal of Infectious Diseases

Volumn 206, Issue 1, 2012, Pages 6-14

  Mlisana, Koleka ^a,b,c   Naicker, Nivashnee ^a   Werner, Lise ^a   Roberts, Lindi ^d   Van Loggerenberg, Francois ^a   Baxter, Cheryl ^a   Passmore, Jo Ann S ^a,c,d   Grobler, Anneke C ^a   Sturm, A Willem ^b   Williamson, Carolyn ^a,c,d   Ronacher, Katharina ^e   Walzl, Gerhard ^e   Abdool Karim, Salim S ^a,f  

^a UNIVERSITY OF KWAZULU NATAL   (South Africa)

^b UNIVERSITY OF KWAZULU NATAL   (South Africa)

^c NATIONAL HEALTH LABORATORY SERVICE   (South Africa)

^d UNIVERSITY OF CAPE TOWN   (South Africa)

^e UNIVERSITY OF STELLENBOSCH   (South Africa)

^f Och Spine at New York Presbyterian Hospitals   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CD40 LIGAND; FLT3 LIGAND; INTERLEUKIN 12P70; INTERLEUKIN 13; INTERLEUKIN 17; INTERLEUKIN 1ALPHA; INTERLEUKIN 1BETA; INTERLEUKIN 2; INTERLEUKIN 8; LYMPHOTOXIN; RANTES; TUMOR NECROSIS FACTOR ALPHA; VASCULOTROPIN;

ADULT; ANTIBODY DETECTION; ARTICLE; ASYMPTOMATIC DISEASE; CHLAMYDIA TRACHOMATIS; COHORT ANALYSIS; CONTROLLED STUDY; DISEASE ASSOCIATION; FEMALE; FEMALE GENITAL TRACT INFLAMMATION; GYNECOLOGICAL EXAMINATION; HERPES SIMPLEX VIRUS 2; HIGH RISK POPULATION; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS 1 INFECTION; INCIDENCE; INFECTION RISK; INFECTION SENSITIVITY; LABORATORY TEST; MAJOR CLINICAL STUDY; MYCOPLASMA GENITALIUM; NEISSERIA GONORRHOEAE; OBSERVATIONAL STUDY; PREDICTIVE VALUE; PREDICTOR VARIABLE; PREVALENCE; PRIORITY JOURNAL; PROSPECTIVE STUDY; SENSITIVITY AND SPECIFICITY; SEXUALLY TRANSMITTED DISEASE; SOUTH AFRICA; SYMPTOM; TRICHOMONAS VAGINALIS; VAGINA DISCHARGE;

ADULT; COHORT STUDIES; CYTOKINES; FEMALE; FOLLOW-UP STUDIES; GENITALIA, FEMALE; HIV INFECTIONS; HIV-1; HUMANS; INCIDENCE; INFLAMMATION; PREVALENCE; REPRODUCTIVE TRACT INFECTIONS; SEXUALLY TRANSMITTED DISEASES; SOUTH AFRICA; VAGINAL DISCHARGE;

EID: 84861558518     PISSN: 00221899     EISSN: None     Source Type: Journal    
DOI: 10.1093/infdis/jis298     Document Type: Article

References (46)

1. Johnson LF, Dorrington RE, Bradshaw D, Coetzee DJ. The effect of syndromic management interventions on the prevalence of sexually transmitted infections in South Africa. Sex Reprod Healthc 2011; 2:13-20.
2. UNAIDS. UNAIDS report on the global AIDS Epidemic 2010. Geneva: Joint United Nations Programme on HIV/AIDS, 2010. Available at: http://www.unaids.org/ globalreport/Accessed 11 February 2011.
3. Rehle T, Shisana O, Pillay V, Zuma K, Puren A, Parker W. National HIV incidence measures-new insights into the South African epidemic. S Afr Med J 2007; 97:194-9.
4. Stamm WE, Handsfield HH, Rompalo AM, Ashley RL, Roberts PL, Corey L. The association between genital ulcer disease and acquisition of HIV infection in homosexual men. JAMA 1988; 260:1429-33.
5. Plummer FA, Simonsen JN, Cameron DW, et al. Cofactors in malefemale sexual transmission of human immunodeficiency virus type 1. J Infect Dis 1991; 163:233-9.
6. Wasserheit JN. Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992; 19:61-77.
7. Laga M, Manoka A, Kivuvu M, et al. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS 1993; 7:95-102.
8. Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet 1997; 349:1868-73.
9. Cohen MS. Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis. Lancet 1998; 351(Suppl 3):5-7.
10. McClelland RS, Wang CC, Mandaliya K, et al. Treatment of cervicitis is associated with decreased cervical shedding of HIV-1. AIDS 2001; 15:105-10.
11. Ramjee G, Williams B, Gouws E, Van Dyck E, De Deken B, Karim SA. The impact of incident and prevalent herpes simplex virus-2 infection on the incidence of HIV-1 infection among commercial sex workers in South Africa. JAIDS 2005; 39:333-9.
12. World Health Organization. Guidelines for the management of sexually transmitted infections. Available at: http://www.who.int/hiv/pub/sti/en/ STIGuidelines2003.pdf. Accessed 14 March 2011.
13. Moodley P, Sturm AW. Management of vaginal discharge syndrome: how effective is our strategy? Int J Antimicrob Agents 2004; 24(Suppl 1): S4-7.
14. Bogaerts J, Ahmed J, Akhter N, Begum N, Van Ranst M, Verhaegen J. Sexually transmitted infections in a basic healthcare clinic in Dhaka, Bangladesh: syndromic management for cervicitis is not justified. Sex Transm Infect 1999; 75:437-8.
15. Pettifor A, Walsh J, Wilkins V, Raghunathan P. How effective is syndromic management of STDs? A review of current studies. Sex Transm Dis 2000; 27:371-85.
16. Behets FM, Miller WC, Cohen MS. Syndromic treatment of gonococcal and chlamydial infections in women seeking primary care for the genital discharge syndrome: decision-making. Bull World Health Organ 2001; 79:1070-5.
17. Desai VK, Kosambiya JK, Thakor HG, Umrigar DD, Khandwala BR, Bhuyan KK. Prevalence of sexually transmitted infections and performance of STI syndromes against aetiological diagnosis, in female sex workers of red light area in Surat, India. Sex Transm Infect 2003; 79:111-5.
18. Pepin J, Deslandes S, Khonde N, et al. Low prevalence of cervical infections in women with vaginal discharge in west Africa: implications for syndromic management. Sex Transm Infect 2004; 80:230-5.
19. Wilkinson D, Abdool Karim SS, Harrison A, et al. Unrecognized sexually transmitted infections in rural South African women: a hidden epidemic. Bull World Health Organ 1999; 77:22-8.
20. Moodley P, Sturm AW. Sexually transmitted infections, adverse pregnancy outcome and neonatal infection. Semin Neonatol 2000; 5:255-69.
21. Wawer MJ, Sewankambo NK, Serwadda D, et al. Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. Rakai Project Study Group. Lancet 1999; 353: 525-35.
22. Kaul R, Kimani J, Nagelkerke NJ, et al. Monthly antibiotic chemoprophylaxis and incidence of sexually transmitted infections and HIV-1 infection in Kenyan sex workers: a randomized controlled trial. JAMA 2004; 291:2555-62.
23. Gray RH, Wawer MJ, Brookmeyer R, et al. Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. Lancet 2001; 357:1149-53.
24. Celum C, Wald A, Hughes J, et al. Effect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with men: a randomised, double-blind, placebo-controlled trial. Lancet 2008; 371:2109-19.
25. Watson-Jones D, Weiss HA, Rusizoka M, et al. Effect of herpes simplex suppression on incidence of HIV among women in Tanzania. New Engl J Med 2008; 358:1560-1571.
26. Grosskurth H, Mosha F, Todd J, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 1995; 346:530-6.
27. Grosskurth H, Gray R, Hayes R, Mabey D, Wawer M. Control of sexually transmitted diseases for HIV-1 prevention: understanding the implications of the Mwanza and Rakai trials. Lancet 2000; 355:1981-7.
28. Kamali A, Quigley M, Nakiyingi J, et al. Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial. Lancet 2003; 361:645-52.
29. Gregson S, Adamson S, Papaya S, et al. Impact and process evaluation of integrated community and clinic-based HIV-1 control: a cluster-randomised trial in eastern Zimbabwe. PLoS Med 2007; 4: e102.
30. Wiesenfeld HC, Hillier SL, Krohn MA, et al. Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstet Gynecol 2002; 100:456-63.
31. Osborn L, Kunkel S, Nabel GJ. Tumor necrosis factor alpha and interleukin 1 stimulate the human immunodeficiency virus enhancer by activation of the nuclear factor kappa B. Proc Natl Acad Sci USA 1989; 86:2336-40.
32. Swingler S, Mann A, Jacque J, et al. HIV-1 Nef mediates lymphocyte chemotaxis and activation by infected macrophages. Nat Med 1999; 5:997-1003.
33. Li Q, Estes JD, Schlievert PM, et al. Glycerol monolaurate prevents mucosal SIV transmission. Nature 2009; 458:1034-8.
34. Nkwanyana NN, Gumbi PP, Roberts L, et al. Impact of human immunodeficiency virus 1 infection and inflammation on the composition and yield of cervical mononuclear cells in the female genital tract. Immunology 2009; 128:e746-57.
35. Madara JL, Stafford J. Interferon-gamma directly affects barrier function of cultured intestinal epithelial monolayers. J Clin Invest 1989; 83:724-7.
36. Schmitz H, Epple HJ, Fromm M, Riecken EO, Schulzke JD. Tumor necrosis factor-alpha (TNF-a) impairs barrier function in epithelial monolayers of HT-29/B6 cells. Gastroenterol 1995; 108:A322.
37. Nazli A, Chan O, Dobson-Belaire WN, et al. Exposure to HIV-1 directly impairs mucosal epithelial barrier integrity allowing microbial translocation. PLoS Pathog 2010; 6:e1000852.
38. van Loggerenberg F, Mlisana K, Williamson C, et al. Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection study. PLoS One 2008; 3:e1954.
39. Sturm PD, Moodley P, Khan N, et al. Aetiology of male urethritis in patients recruited from a population with a high HIV prevalence. Int J Antimicrob Agents 2004; 24(Suppl 1):S8-14.
40. Moodley P, Sturm PD, Vanmali T, Wilkinson D, Connolly C, Sturm AW. Association between HIV-1 infection, the etiology of genital ulcer disease, and response to syndromic management. Sex Transm Dis 2003; 30:241-5.
41. Bebell LM, Passmore JA, Williamson C, et al. Relationship between levels of inflammatory cytokines in the genital tract and CD4+ cell counts in women with acute HIV-1 infection. J Infect Dis 2008; 198:710-4.
42. Columb MO, Sagadai S. Multiple comparisons. Curr Anaesth Crit Care 2006; 17:233-6.
43. White RG, Moodley P, McGrath N, et al. Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa. Sex Transm Infect 2008; 84:528-34.
44. Roberts CM, Pfister JR, Spear SJ. Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis 2003; 30:797-800.
45. Mania-Pramanik J, Kerkar SC, Mehta PB, Potdar S, Salvi VS. Use of vaginal pH in diagnosis of infections and its association with reproductive manifestations. J Clin Lab Anal 2008; 22:375-9.
46. Madhivanan P, Krupp K, Hardin J, Karat C, Klausner JD, Reingold AL. Simple and inexpensive point-of-care tests improve diagnosis of vaginal infections in resource constrained settings. Trop Med Int Health 2009; 14:703-8.