Objectives To determine trends in the relative prevalence of aetiologies of urethral discharge (UDS), vaginal discharge (VDS) and genital ulcer (GUS) syndromes, and in the seroprevalence of syphilis, HSV-2 and HIV.
Methods Consecutive male (UDS/GUS) and female (VDS/GUS) patients were enrolled at Alexandra Health Centre, Johannesburg from January to April each year during 2007–2010. Urethral swabs (UDS), endocervical swabs/vaginal smears (VDS), genital ulcer swabs/smears (GUS) and sera (all) were collected with written informed consent. Real-time PCR assays were used to detect Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) from UDS/VDS swabs, and herpes simplex virus (HSV), Treponema pallidum (TP) Haemophilus ducreyi (HD) and Chlamydia trachomatis L1-3 (LGV) from ulcer swabs. Slides were stained for bacterial vaginosis/candidiasis (BV/CA, VDS) and granuloma inguinale (GI, GUS). Sera were tested for syphilis (rapid plasmin reagin, RPR; Omega Diagnostics), for HSV-2 (HerpeSelect IgG; Focus Diagnostics) and for HIV (Determine; Abbott Laboratories). χ2 for linear trend analyses were undertaken with summary data (Prism v.2, GraphPad Software).
Results 928 UDS, 805 VDS and 455 GUS patients were recruited overall. Trends in the relative prevalence of most syndrome aetiologies were non-significant between 2007 and 2011—NG (UDS, 71%–79%; VDS 11%–17%), CT (UDS, 20%–25%; VDS, 27%–37%), MG (UDS, 10%–13%; VDS, 11%–14%), BV (VDS, 30%–36%), CA (VDS, 26%–31%), HSV (GUS, 53%–75%), TP (GUS, 4%–7%), HD (GUS, 0%–2%), LGV (0%–2%). There were no cases of GI. There was, however, significant decreasing trends for TV detection among UDS (4%–13%, p=0.003) and VDS (19%–34%, p=0.001) patients. Serologically, VDS patients had a decreasing trend in RPR seropositivity (1–8%, p<0.001) and, importantly, HIV coinfections decreased among both UDS (29%–39%, p=0.011) and GUS (60%–75%, p=0.032) patients. Non-significant variations in seropositivity were observed for RPR tests among UDS (1%–3%) and GUS (4%–11%) patients, for HSV-2 among all groups (UDS, 50%–60%; VDS, 74%–84%; GUS, 81%–87%), and for HIV among VDS (48%–59%) patients.
Conclusions These data suggest significant decreases in the prevalence of HIV coinfection in UDS/GUS patients and of trichomoniasis as a cause of UDS/VDS. Though the HIV trends are encouraging for men, the lack of a similar trend for women with VDS is of public health concern.