Background In many countries, sexually transmitted infections (STI) are treated syndromically. Thus, male and female patients with genital discharge syndromes (GDS) receive antimicrobials covering Chlamydia trachomatis (CT), Neisseria Gonorrhoeae (NG) and Trichomonas vaginalis (TV) infections and bacterial vaginosis (BV) among women. However, periodic surveys into the aetiology of GDS are necessary to inform treatment guidelines.
Methods For this study, we enrolled 400 patients with GDS at 6 regionally diverse clinics in Zimbabwe. To date, test procedures have been completed for patients enrolled at the Harare study sites (N = 137). Sites were visited sequentially by a mobile unit of 3 trained nurses to enrol patients with STI syndromes, including GDS. STI history and risk data were collected by questionnaire and uploaded to a web-based database. Urine and vaginal specimens were taken for testing with a validated multiplex polymerase chain reaction assay (M-PCR, National Institute of Communicable Diseases, Johannesburg) for CT, NG, TV and Mycoplasma genitalium (MG). Smears for Gram stain and subsequent assessment using Nugent criteria for the diagnosis of BV were obtained from all women with vaginal discharge.
Results M-PCR testing is complete for all GDS patients enrolled in Harare; 68 men and 69 women. Positivity rates were as follows. Men: NG = 60.3%, CT = 13.2%, TV = 4.4%, MG = 2.9%. Women: NG = 18.8%, CT = 8.7%, TV = 14.5%, MG = 7.3%. Among women, 31.9% met Nugent criteria for BV and 20.0% had yeast infection identified on Gram stain.
Conclusions In this preliminary analysis, gonorrhoea was the most common cause of GDS among both men and women, but much more common among men. Chlamydia infections were substantially less common among both men and women and trichomoniasis was more common than chlamydia infections among women. Regardless of investigated microbiologic causes, many women met criteria for BV. M. genitalium infections were uncommon overall. These findings will inform development of future syndromic STI management guidelines.
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