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Symptomatic vaginal discharge is a poor predictor of sexually transmitted infections and genital tract inflammation in high-risk women in South Africa.

dc.contributor.authorMlisana, Koleka Patience.
dc.contributor.authorNaicker, Nivashnee.
dc.contributor.authorWerner, Lise.
dc.contributor.authorRoberts, Lindi.
dc.contributor.authorvan Loggerenberg, Francois.
dc.contributor.authorBaxter, Cheryl.
dc.contributor.authorPassmore, Jo-Ann Shelley.
dc.contributor.authorGrobler, Anna Christina.
dc.contributor.authorSturm, Adriaan Willem.
dc.contributor.authorWilliamson, Carolyn.
dc.contributor.authorRonacher, Katharina.
dc.contributor.authorWalzl, Gerhard.
dc.contributor.authorAbdool Karim, Salim Safurdeen.
dc.date.accessioned2013-06-25T07:25:26Z
dc.date.available2013-06-25T07:25:26Z
dc.date.created2011
dc.date.issued2011
dc.description.abstractBackground. Diagnosis and treatment of sexually transmitted infections (STIs) is a public health priority, particularly in regions where the incidence of human immunodeficiency virus (HIV) infection is high. In most developing countries, STIs are managed syndromically. We assessed the adequacy of syndromic diagnosis of STIs, compared with laboratory diagnosis of STIs, and evaluated the association between STI diagnosis and the risk of HIV acquisition in a cohort of high-risk women. Methods. HIV-uninfected high-risk women (n = 242) were followed for 24 months. Symptoms of STIs were recorded, and laboratory diagnosis of common STI pathogens was conducted every 6 months. Forty-two cytokines were measured by Luminex in cervicovaginal lavage specimens at enrollment. Human immunodeficiency virus type 1 (HIV-1) infection was evaluated monthly. Results. Only 12.3% of women (25 of 204) who had a laboratory-diagnosed, discharge-causing STI had clinically evident discharge. Vaginal discharge was thus a poor predictor of laboratory-diagnosed STIs (sensitivity, 12.3%; specificity, 93.8%). Cervicovaginal cytokine concentrations did not differ between women with asymptomatic STIs and those with symptomatic STIs and were elevated in women with asymptomatic STIs, compared with women with no STIs or bacterial vaginosis. Although laboratory-diagnosed STIs were associated with increased risk of HIV infection (hazard ratio, 3.3 [95% confidence interval, 1.5–7.2)], clinical symptoms were not. Conclusions. Syndromic STI diagnosis dependent on vaginal discharge was poorly predictive of laboratory-diagnosed STI. Laboratory-diagnosed STIs were associated with increased susceptibility to HIV acquisition, while vaginal discharge was not.en
dc.identifier.citationMlisana, K. et al. 2012. Symptomatic vaginal discharge is a poor predictor of sexually transmitted infections and genital tract inflammation in high-risk women in South Africa. The Journal of Infectious Diseases 206 (1) pp. 6-14.en
dc.identifier.issn0022-1899
dc.identifier.urihttp://dx.doi.org/10.1093/infdis/jis298en
dc.identifier.urihttp://hdl.handle.net/10413/9190
dc.language.isoenen
dc.publisherOxford University Press.en
dc.subjectAIDS (Disease) in women--South Africa.en
dc.subjectSexually transmitted diseases--South Africa.en
dc.subjectHIV infections--South Africa.en
dc.subject.otherHigh-risk women.en
dc.subject.otherGenital tract inflammations.en
dc.titleSymptomatic vaginal discharge is a poor predictor of sexually transmitted infections and genital tract inflammation in high-risk women in South Africa.en
dc.typePeer reviewed journal articleen

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