title: Symptomatic vaginal discharge is a poor predictor of sexually transmitted infections and genital tract inflammation in high-risk women in South Africa.
abstract: BACKGROUND
  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.
authors.affiliation: Centre for the AIDS Programme of Research, South Africa. michelle.clarke@adelaide.edu.au
authors.forename: Koleka
authors.initials: K
authors.lastname: Mlisana
authors.forename: Nivashnee
authors.initials: N
authors.lastname: Naicker
authors.forename: Lise
authors.initials: L
authors.lastname: Werner
authors.forename: Lindi
authors.initials: L
authors.lastname: Roberts
authors.forename: Francois
authors.initials: F
authors.lastname: van Loggerenberg
authors.forename: Cheryl
authors.initials: C
authors.lastname: Baxter
authors.forename: Jo-Ann S
authors.initials: JA
authors.lastname: Passmore
authors.forename: Anneke C
authors.initials: AC
authors.lastname: Grobler
authors.forename: A Willem
authors.initials: AW
authors.lastname: Sturm
authors.forename: Carolyn
authors.initials: C
authors.lastname: Williamson
authors.forename: Katharina
authors.initials: K
authors.lastname: Ronacher
authors.forename: Gerhard
authors.initials: G
authors.lastname: Walzl
authors.forename: Salim S
authors.initials: SS
authors.lastname: Abdool Karim
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016207:Cytokines / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D005836:Genitalia, Female / Q000473:pathology / Q000821:virology; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D015995:Prevalence; D060737:Reproductive Tract Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D013019:South Africa / Q000453:epidemiology; D019522:Vaginal Discharge / Q000175:diagnosis* / Q000821:virology
chemical_list: D016207:Cytokines