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Epidemiology & Monitoring

Category: STI - general

(P355) Co- prevalent sexually transmitted infections among individuals presenting with genital ulcer disease in Zimbabwe

Wednesday, July 26, 2023
16:00 – 18:00 CST
Background

Syndromic management of sexually transmitted infections (STIs) is the standard of care in resource-constrained settings. Co-prevalent STIs, if asymptomatic, may remain unidentified when individuals present with a particular syndrome. We investigated the prevalence of co-prevalent STIs in individuals with genital ulcer disease (GUD) syndrome in Zimbabwe (GUD data to be presented elsewhere).



Methods

We consecutively enrolled individuals aged ≥16 years presenting with GUD at two primary health care clinics in Harare. Socio-demographic data, sexual behavior and clinical history were collected. Genital ulcer swabs were collected to test for GUD aetiology. Urine was collected to test for Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) using the GeneXpert platform. Those with symptoms were managed syndromically; asymptomatic participants with a positive test result were contacted within 7 days for treatment. Self-collected vaginal swabs were used to test for Trichomonas vaginalis (TV) using a point-of-care (POC) lateral flow assay in females and treated immediately. All participants were offered an HIV test (unless known HIV-positive).



Results

From July-December 2022, 160 participants were recruited (53.1% female, median age 27 years). A total of 48/160 (30%) were HIV-positive with 12/48 (25.0%) newly diagnosed. Overall, 50/160 (31.3%, 95% CI: 24.2 – 39.0) participants had CT and/or GC: the prevalence of CT and GC were 23.8% (95% CI: 17.4 – 31.1) and 16.9% (95% CI: 11.4 – 23.6) respectively. Among those with NG/CT, 82.0% completed treatment, of whom only 34.1% had symptoms and therefore treated syndromically. TV prevalence was 25.9% (95% CI: 16.9 – 36.5), of whom 72.7% (16/22) were symptomatic. All were treated on the same day.



Younger age (OR 1.08 for every year lower age, 95% CI:1.03-1.13) and not using a condom at last sexual intercourse (OR = 2.50, 95% CI:1.01-6.17) were associated with increased odds of a co-prevalent STI (excluding HIV); positive HIV status was not associated with having a co-prevalent STI.



Conclusion

There was high prevalence of HIV and other co-prevalent STIs among GUD treatment seekers. While HIV testing is routinely offered, testing for other STIs should be considered among individuals presenting with STI syndromes such as GUD. POC tests facilitate completion of treatment.