Bacterial etiology of sexually transmitted infections at a STI clinic in Ghana; use of multiplex real time PCR

Augustina A Sylverken,Denis D Yar,Nana Yaa Awua-Boateng,Ellis Owusu-Dabo,Thomas Agyarko-Poku,John H Amuasi,Portia B Okyere,Samson P Salifu

doi:10.4314/gmj.v50i3.5

Abstract

Background: Most sexually transmitted infection (STI) management efforts focus on the syndromic approach to diagnose and treat patients. However, most women with STIs have been shown to be entirely asymptomatic, or if symptoms exist, are often missed when either clinical or conventional bacteriologic diagnostic tools are employed.Methods: We assessed the performance of a multiplex real time PCR assay to describe other potential pathogens that could be missed by conventional bacteriological techniques in 200 women attending a routine STI clinic in Kumasi, Ghana.Results: Although a total 78.00% of the women were asymptomatic, 77.1% of them tested positive for at least one bacterial STI pathogen. Mycoplasma genitalium was the most commonly detectable pathogen present in 67.5% of all women. Of those testing positive, 25.0% had single infections, while 38.0% and 19.5% had double and triple infections respectively. Altogether, 86.54% and 90.91% of the symptomatic and asymptomatic women respectively tested positive for at least one pathogen (p<0.05). There were no significant associations (p<0.05) between the clinical manifestations of the symptomatic women and the pathogens detected in their samples.Conclusions: Our study confirmed the importance of complementing the syndromic approach to STI management with pathogen detection and most importantly recognise that STIs in women are asymptomatic and regular empirical testing even for both symptomatic and asymptomatic patients is critical for complete clinical treatment.Funding: EOD (Ellis Owusu-Dabo Research working group, KCCR)Keywords: Etiology, Syndromic, Sexually Transmitted Infections, Multiplex real time PCR

Highlights

Transmitted infections (STIs) are a group of communicable diseases that are transferred predominantly by sexual contact
Association between Clinical presentation and pathogen detection A total 78.00% of the women were symptomatic
This study reports on the use of a multiplex real time PCR system to determine bacterial etiology and distribution of sexually transmitted infection (STI) pathogens among women visiting a STI clinic in Ghana

Summary

Introduction

Transmitted infections (STIs) are a group of communicable diseases that are transferred predominantly by sexual contact. It is estimated that more than 340 million new cases of curable STIs occur every year throughout the world among adults aged 15-49 years, with the second largest proportion in sub-Saharan Africa.[1] In most developing countries, STIs and their complications are among the top five diseases for which sexually active adults seek health care.[2] Women of childbearing age bear the brunt of major complications resulting from STIs such as infertility, chronic pelvic pain, pelvic inflammatory diseases and ectopic pregnancy.[3]. Viral and fungal pathogens are known to spread by sexual contact. The significant bacterial pathogens include Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG). Infections caused by most of these pathogens are known to be curable by employing appropriate antimicrobial treatment regimens.[2]

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