title: Epidemiology of curable sexually transmitted infections among women at increased risk for HIV in northwestern Tanzania: inadequacy of syndromic management.
abstract: BACKGROUND
  Curable, non-viral pathogens account for a significant burden of sexually transmitted infections (STIs), and there is established evidence that STIs increase both HIV acquisition and transmission. We investigated the prevalence, trends, and factors associated with Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Treponema pallidum, and the performance of syndromic management, among a cohort of women working in bars, hotels, and other food and recreational facilities near large-scale mines in northwestern Tanzania.
  
  
  METHODS
  HIV-negative women aged 18-44 years (N = 966) were enrolled and followed for 12 months in a microbicides feasibility study. We collected sociodemographic and behavioural data, performed clinical examinations, and tested for STIs, at enrolment and 3-monthly. Risk factors for STIs were investigated using logistic regression models with random effects. Sensitivity, specificity and predictive values of syndromic management were calculated.
  
  
  RESULTS
  At enrolment, the prevalences of C. trachomatis, N. gonorrhoeae, T. vaginalis, and high-titre active syphilis were 111/956 (12%), 42/955 (4%), 184/945 (19%) and 46/965 (5%), respectively. There were significant decreases over time for C. trachomatis and T. vaginalis (OR trend per month: 0.94 [95% CI 0.91, 0.97]; and 0.95 [0.93, 0.98], respectively; both p<0.001). The majority of these infections were not diagnosed by the corresponding syndrome; therefore, most participants were not treated at the diagnosis visit. Syndromic management was poorly predictive of laboratory-diagnosed infections. We identified a number of risk factors for STIs, including low educational level, some sexual behaviours, and ever having been pregnant.
  
  
  CONCLUSIONS
  This analysis demonstrates that the prevalences of curable STIs are high among women who work in food and recreational facilities in northwestern Tanzania. Most of these infections are missed by syndromic management. Accurate and affordable rapid-point-of-care tests and innovative interventions are needed to reduce the burden of STIs in this population which is at increased risk for HIV.
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Suzanna C
authors.initials: SC
authors.lastname: Francis
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Trong T
authors.initials: TT
authors.lastname: Ao
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Vanobberghen
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania; National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chilongani
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Ramadhan
authors.initials: R
authors.lastname: Hashim
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Aura
authors.initials: A
authors.lastname: Andreasen
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Deborah
authors.initials: D
authors.lastname: Watson-Jones
authors.affiliation: National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Saidi
authors.initials: S
authors.lastname: Kapiga
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D018023:HIV Seronegativity; D006801:Humans; D015995:Prevalence; D012306:Risk; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult