Urethritis/cervicitis pathogen prevalence and associated risk factors among asymptomatic HIV-infected patients in South Africa.
BACKGROUND
To determine sexually transmitted infection (STI) prevalence, and patient characteristics associated with detection of urethritis/cervicitis pathogens, among HIV-infected individuals offered voluntary STI screening at a South African HIV treatment center.


METHODS
Individuals, asymptomatic for genital discharge, were screened for Neisseria gonorrhoeae (NG), Chlamydia trachomatis, Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) infections (real-time polymerase chain reaction assay), for syphilis and herpes simplex type 2 (serologically), and for bacterial vaginosis and Candida (microscopy, women only). Patients' most recent CD4 and viral load results were recorded. Demographic, clinical, and behavioral data were collected by nurse-administered questionnaire.


RESULTS
Compared with men (n = 551), women (n = 558) were younger (mean age, 35.0 vs. 37.9 years; P < 0.001), reported more STIs in the past year (65.5% vs. 56.5%; P = 0.002), had more urethritis/cervicitis pathogens detected (21.3% vs.16.4%, P = 0.035), and were less aware of their partner's HIV status (53.1% vs. 62.3%; P = 0.007). The overall prevalence of individual urethritis/cervicitis pathogens was TV (7.6%), MG (6.1%), NG (5.4%), and C. trachomatis (2.1%). Multivariate analysis highlighted 4 significant factors associated with the detection of specific urethritis/cervicitis pathogens, namely female gender (TV, adjusted odds ratio [aOR] 2.53, 95% confidence interval [CI]: 1.47-4.37), having a regular sexual partner in the past 3 months (NG, aOR 2.26, 95% CI: 1.01-5.08), suboptimal condom use with regular partners (TV, aOR 2.07, 95% CI: 1.25-3.42), and a history of genital warts in the past year (NG, 2.25, 95% CI: 1.26-4.03).


CONCLUSIONS
Asymptomatic urethritis/cervicitis pathogens were highly prevalent in this population. Few urethritis/cervicitis pathogen-associated patient characteristics were identified, emphasizing the need for affordable STI diagnostics to screen HIV-infected patients.
Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa. davidl@nicd.ac.za
David A
DA
Lewis
Tobias F
TF
Chirwa
Veerle M Y
VM
Msimang
Frans M
FM
Radebe
Mary L
ML
Kamb
Cynthia S
CS
Firnhaber
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000465:Algorithms; D018791:CD4 Lymphocyte Count; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D045704:Mycoplasma genitalium / Q000472:pathogenicity*; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods; D015995:Prevalence; D012307:Risk Factors; D012747:Sexual Partners; D013019:South Africa / Q000453:epidemiology; D014246:Trichomonas vaginalis / Q000302:isolation & purification*; D014526:Urethritis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D002575:Uterine Cervicitis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D019562:Viral Load