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The detection of urethritis pathogens among patients with the male urethritis syndrome, genital ulcer syndrome and HIV VCT clients: should South Africa's syndromic management approach be revised?
  1. Vivian Black (vblack{at}rhru.co.za)
  1. Reproductive Health and HIV Research Unit, South Africa
    1. Precious Magooa (pmagooa{at}nicd.ac.za)
    1. Sexually Transmitted Infections Reference Centre, National Institute for Communicable Diseases, South Africa
      1. Frans Radebe (fransr{at}nicd.ac.za)
      1. Sexually Transmitted Infections Reference Centre, National Institute for Communicable Diseases, South Africa
        1. Mandy Myers (mandy.myers{at}bpas.org)
        1. Reproductive Health and HIV Research Unit, South Africa
          1. Cadwill Pillay (cadzster{at}gmail.com)
          1. Sexually Transmitted Infections Reference Centre, National Institute for Communicable Diseases, South Africa
            1. David A Lewis (davidl{at}nicd.ac.za)
            1. Sexually Transmitted Infections Reference Centre, National Institute for Communicable Diseases, South Africa

              Abstract

              Objectives: To determine the prevalence of urethritis pathogens amongst symptomatic urethritis (MUS) patients, genital ulcer (GUS) patients without urethritis symptoms, and men requesting HIV testing (VCT).

              Methods: A prospective study was conducted in Johannesburg, South Africa. Men from the three groups were screened for urethritis pathogens using molecular tests and culture of Neisseria gonorrhoeae and (initially) trichomoniasis. Antimicrobial susceptibility testing was undertaken for ciprofloxacin on all gonococcal isolates; ciprofloxacin resistant isolates were screened for ceftriaxone resistance.

              Results: 664 participants were recruited (438 MUS, 76 GUS, and 158 VCT) over two years. Gonorrhoea was detected in 62.3% MUS, 15.8% GUS and 3.2% VCT participants. Chlamydial infection was detected in 19.3% MUS, 13.2% GUS and 8.2% VCT participants. Trichomoniasis was detected in 4.9% MUS, 19.7% GUS and 3.8% VCT participants. Mycoplasma genitalium infection was detected in 14.4% MUS, 13.2% GUS and 7.0% in VCT participants. Ciprofloxacin resistance increased from 13.0% in the first year to 26.3% in the second year; all resistant isolates were susceptible to ceftriaxone.

              Conclusions: Urethritis pathogens, including T. vaginalis, should be covered in syndromic management therapy of genital ulcers in the absence of clinical urethritis. Consideration should be given to adding metronidazole to existing MUS therapy. Ciprofloxacin can no longer be relied upon to treat presumptive gonococcal infections efficaciously in South Africa.

              • genital ulceration
              • gonorrhoea
              • male urethritis,
              • syndromic management
              • trichomoniasis

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