Abstract
BackgroundIn South Africa, treatment of genital ulcer disease (GUD) occurs in the context of syndromic management. GUD aetiological studies have been conducted in Johannesburg since 2007. We report on GUD pathogen prevalence, sero-prevalence of STI co-infections and aetiological trends among GUD patients presenting to a community-based primary healthcare facility in Johannesburg over a 9-year period.Methods and findingsGUD surveys were conducted from January to April each year. Consecutive genital ulcers were sampled from consenting adults. Swab-extracted DNA was tested by multiplex real-time PCR assays for herpes simplex virus (HSV), Treponema pallidum (TP), Haemophilus ducreyi (HD) and Chlamydia trachomatis (CT). HSV-positive DNA extracts were further subtyped into HSV-1 and HSV-2 using a commercial PCR assay; CT-positive extracts were tested with an in-house PCR assay specific for serovars L1-L3 (lymphogranuloma venereum). Sera were tested for HIV, HSV-2, and syphilis co-infections. Giemsa-stained ulcer smears were screened for Klebsiella granulomatis by microscopy. Data were analysed with STATATM version 14. Of 771 GUD specimens, 503 (65.2%) had a detectable pathogen: HSV 468 (60.7%); TP 30 (3.9%); CT L1-3 7 (0.9%); HD 4 (0.5%). No aetiological agents were detected in 270 (34.8%) ulcer specimens. Seroprevalence rates were as follows: HIV 61.7%; HSV-2 80.2% and syphilis 5.8%. There was a strong association between GUD pathogen detection and HIV seropositivity (p < 0.001); 68% of cases caused by HSV were co-infected with HIV. There was a significant decline in the relative prevalence of ulcer-derived HSV over time, predominantly from 2013–2015 (p-value for trend = 0.023); and a trend towards a decrease in the HIV seropositivity rate (p-value for trend = 0.209).ConclusionsHSV remains the leading cause of pathogen-detectable GUD in South Africa. The prevalence of HIV co-infection among GUD patients is high, underlining the importance of linkage to universal HIV testing and treatment in primary healthcare settings.
Highlights
Genital ulcer disease (GUD) has been recognized as a significant risk factor in the acquisition and transmission of human immunodeficiency virus (HIV) infection in Africa.[1,2,3,4] In South Africa, the HIV infection prevalence among adults in the reproductive age group was estimated to be 19.2% in 2015.[5]
We report on genital ulcer disease (GUD) pathogen prevalence, sero-prevalence of sexually transmitted infection (STI) co-infections and aetiological trends among GUD patients presenting to a community-based primary healthcare facility in Johannesburg over a 9-year period
Swab-extracted DNA was tested by multiplex realtime polymerase chain reaction (PCR) assays for herpes simplex virus (HSV), Treponema pallidum (TP), Haemophilus ducreyi (HD) and Chlamydia trachomatis (CT)
Summary
Genital ulcer disease (GUD) has been recognized as a significant risk factor in the acquisition and transmission of human immunodeficiency virus (HIV) infection in Africa.[1,2,3,4] In South Africa, the HIV infection prevalence among adults in the reproductive age group was estimated to be 19.2% in 2015.[5]. Treatment of genital ulcer disease (GUD) in South Africa occurs in the context of syndromic management at primary healthcare level with the use of standard treatment guidelines.[6] Syndromic management of STIs ensures that the major sexually transmitted pathogens responsible for the condition are correctly treated. It is recommended by the WHO as a pragmatic strategy in areas that lack the requisite resources or diagnostic facilities for universal aetiological testing.[7] The epidemiology of GUD in South Africa underwent a paradigm shift in the early 2000s at the onset of the HIV epidemic. We report on GUD pathogen prevalence, sero-prevalence of STI co-infections and aetiological trends among GUD patients presenting to a community-based primary healthcare facility in Johannesburg over a 9-year period
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
