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Epidemiology oral session 11: Various topics of special interest
O1-S11.06 Burden of genital discharge pathogens and associated characteristics of asymptomatic HIV-infected patients in Johannesburg, South Africa
  1. D Lewis1,
  2. T Chirwa2,
  3. V Msimang1,
  4. F Radebe1,
  5. M Kamb3,
  6. I Sanne4,
  7. C Firnhaber4
  1. 1National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, South Africa
  2. 2University of the Witwatersrand Johannesburg, South Africa
  3. 3Centers for Disease Control and Prevention, Atlanta, USA
  4. 4Right to Care, Johannesburg, South Africa


Background The prevalence of asymptomatic STIs and urethritis/cervicitis pathogen-associated patient characteristics were determined among patients attending a HIV treatment centre in Johannesburg.

Methods Consenting consecutive HIV-infected patients, asymptomatic for symptoms/signs of genital discharge, were screened over 12 months for gonorrhoea, trichomoniasis, chlamydial and Mycoplasma genitalium infections using a real-time PCR assay. Bacterial vaginosis (BV) and Candida were detected by microscopy (women only). Serological assays diagnosed syphilis (RPR/TPPA) and herpes simplex type 2 (IgG ELISA) infections. Patients returned at 2 weeks; those with positive results were treated and given contact slips for partners. If available, patients' most recent CD4 (83%) and viral load (VL) (60%) results were recorded. Demographic, clinical and behavioural data were collected by nurse-administered questionnaire. A descriptive analysis was conducted to obtain frequency distributions of patient and STI prevalence data. Associations were investigated using the χ2 test at a 5% level of significance. A multiple logistic regression model was fitted to find factors associated with urethritis/cervicitis pathogens.

Results 1109 patients were enrolled (551 men, 558 women). Compared with men, women were younger with a mean age [SD] of 35.0 [7.3] vs 37.9 [7.9] years (p<0.001), reported more STIs in the past year (65.5% vs 56.5%, p=0.002), were less likely to know their partner's HIV status (53.1% vs 62.3%, p=0.007), were more likely to be on HAART (70.4% vs 59.7%, p<0.001) with an undetectable VL (81.0% vs 69.9%, p<0.001) and a higher mean [SD] CD4 count of 346 [203] vs 232 [173] cells/mm3 (p<0.001). Urethritis/cervicitis pathogens were detected in 119/558 (21.3%) women and 90/550 (16.4%) men (p=0.035). BV and Candida were detected in 155 (28.0%) and 101 (18.3%) women, respectively. Detection of urethritis/cervicitis pathogens was associated with recent sexual intercourse with a regular partner (adjusted OR, aOR 1.64, 95% CI 1.08% to 2.48%). Trichomoniasis was associated with female gender (aOR 2.45, 95% CI 1.39% to 4.32%) and sub-optimal condom use with regular partners (aOR 2.04, 95% CI 1.23% to 3.41%).

Conclusions Urethritis/cervicitis pathogens were highly prevalent among this asymptomatic population. The benefit of introducing such STI screening programmes to improve reproductive health and HIV prevention efforts requires further study.

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