Prevalence of sexually transmitted infections (STIs), associations with sociodemographic and behavioural factors, and assessment of the syndromic management of vaginal discharge in women with urogenital complaints in Mozambique

Alice Manjate, Gladys Sergon, Darlenne B. Kenga, D. Golparian, Yuriy Tyulenev, Osvaldo Loquilha, F. Mausse, Alexander Guschin, Jose C Langa, A. Passanduca, J. Sacarlal, M. Unemo
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Abstract

In Mozambique, sexually transmitted infections (STIs) are estimated to be prevalent, but diagnosis and treatment of curable STIs rely only on syndromic management. We examined the prevalence of four non-viral STIs and HIV-1/2, based on etiological diagnosis, associations with sociodemographic and behavioural factors, and the STI diagnostic accuracy of the vaginal discharge syndromic management in women with urogenital complaints in Maputo, Mozambique. A cross-sectional study was performed in Maputo, Mozambique, February 2018–January 2019, enrolling 924 women of reproductive age with urogenital complaints. Endocervical/vaginal swabs were sampled and chlamydia, gonorrhoea, trichomoniasis and Mycoplasma genitalium infections were diagnosed using a multiplex real-time PCR (AmpliSens; InterLabServices). Serological testing was performed for HIV-1/2. A structured questionnaire collected metadata. All data were analyzed in STATA/IC 12.1 using descriptive statistics, chi-square tests and logistic regression model. About 40% of the women were less than 24 years old, 50.8% were single, 62.1% had their sexual debut between 12 and 17 years of age, and the main complaint was vaginal discharge syndrome (85%). The prevalence of chlamydia was 15.5%, trichomoniasis 12.1%, gonorrhoea 4.0%, M. genitalium 2.1%, and HIV-1/2 22.3%. The vaginal discharge syndrome flowchart had a sensitivity of 73.0%–82.5% and a specificity of 14%–15% for the detection of any individual non-viral STI in women with urogenital complaints. In total, 19.2% of the symptomatic women with chlamydia, trichomoniasis or gonorrhoea would not be detected and accordingly treated using the vaginal discharge syndromic management (missed treatment) and 70.0% of the women would be treated despite not being infected with any of these three STIs (overtreatment). In conclusion, a high prevalence of especially chlamydia, trichomoniasis, and HIV-1/2 was found in women of childbearing age with urogenital complaints in Maputo, Mozambique. Syndromic management of vaginal discharge revealed low accuracy in the detection of STIs in symptomatic women, especially low specificity, which resulted in under-treatment of STI-positive cases and incorrect or over-treatment of women with urogenital complaints, many of whom were negative for all the non-viral STIs. Etiological diagnosis is imperative for effective management of STIs in symptomatic and asymptomatic women.
性传播感染(STI)的流行率、与社会人口和行为因素的关系,以及对莫桑比克泌尿生殖系统不适妇女阴道分泌物综合症管理的评估
在莫桑比克,性传播感染(STI)估计很普遍,但对可治愈性传播感染的诊断和治疗仅依赖于综合征管理。我们研究了莫桑比克马普托市患有泌尿生殖系统疾病的妇女中,基于病因诊断的四种非病毒性 STI 和 HIV-1/2 的流行情况、与社会人口和行为因素的关联,以及阴道分泌物综合征管理对 STI 诊断的准确性。2018年2月至2019年1月在莫桑比克马普托进行了一项横断面研究,共招募了924名有泌尿生殖系统不适的育龄妇女。研究人员采集了宫颈内膜/阴道拭子样本,并使用多重实时 PCR(AmpliSens;InterLabServices)诊断衣原体、淋病、滴虫病和生殖器支原体感染。对 HIV-1/2 进行了血清学检测。结构化问卷收集了元数据。所有数据均在 STATA/IC 12.1 中使用描述性统计、卡方检验和逻辑回归模型进行分析。约 40% 的女性年龄小于 24 岁,50.8% 的女性为单身,62.1% 的女性初次性行为年龄在 12 至 17 岁之间,主要主诉为阴道分泌物综合征(85%)。衣原体感染率为 15.5%,滴虫病感染率为 12.1%,淋病感染率为 4.0%,生殖器疟原虫感染率为 2.1%,HIV-1/2 感染率为 22.3%。阴道分泌物综合征流程图在检测泌尿生殖系统不适妇女的任何一种非病毒性 STI 方面的灵敏度为 73.0%-82.5%,特异性为 14%-15%。总之,19.2% 的衣原体、滴虫或淋病症状妇女不会被检测出来,也不会根据阴道分泌物综合症管理方法进行相应的治疗(漏治),70.0% 的妇女尽管没有感染这三种性传播感染中的任何一种,却接受了治疗(过度治疗)。总之,在莫桑比克马普托发现,育龄妇女在出现泌尿生殖系统不适症状时,衣原体、滴虫病和 HIV-1/2 感染率较高。对阴道分泌物的综合管理显示,在有症状的妇女中检测性传播感染的准确性较低,尤其是特异性较低,这导致了对性传播感染阳性病例的治疗不足,以及对泌尿生殖系统主诉妇女的错误或过度治疗,其中许多妇女的所有非病毒性传播感染均为阴性。要对有症状和无症状妇女的性传播感染进行有效治疗,病因诊断必不可少。
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