P09.24 The aetiology of genital ulcer disease and association with hiv infection in zimbabwe. (13th September 2015)

• Record Type: Journal Article
• Authors: Machiha, A; Mugurungi, O; Tshimanga, M; Kilmarx, P; Mungati, M; Nyakura, J; Shambira, G; Gonese, E; Herman-Roloff, A; Kupara, V; Lewis, D; Handsfield, H; Rietmeijer, C
• Is Part Of: Sexually transmitted infections. Volume 91(2015)Supplement 2
• Page Start: A157
• Page End: A157
• Publication Date: 2015-09-13
• Subjects: Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2015-052270.408
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Background: In many countries, sexually transmitted infections (STI) are treated syndromically. Thus, patients diagnosed with genital ulcer disease (GUD) in Zimbabwe receive antimicrobials that cover infections with Treponema pallidum (TP: benzathine penicillin), Haemophilus ducreyi (HD: erythromycin) and herpes simplex virus (HSV: acyclovir). However, periodic surveys into the aetiology of GUD are necessary to inform treatment guidelines. Methods: For this study, we recently completed enrollment of 200 patients with GUD at 6 clinics in Zimbabwe. To date, test procedures have been completed for patients enrolled at Harare clinics (N = 70). Ulcer specimens were obtained for testing using a validated multiplex polymerase chain reaction assay (M-PCR, National Institute of Communicable Diseases, Johannesburg) for TP (primary syphilis), HD (chancroid), HSV (genital herpes) and Chlamydia trachomatis strains associated with lymphogranuloma venereum (CT-LGV). Blood samples were collected for HIV testing by a standard rapid HIV test algorithm (First Response™ followed by Alere HIV 1/2™) and considered positive when reactive on both. Results: To date, M-PCR testing is complete for all 70 patients with GUD recruited from the Harare clinics (38 men and 32 women). Of these, 17 (24.2%) were positive for HSV, 8 (11.4%) were positive for TP, and 1 was positive for CT-LGV. No cases of chancroid were detected. The overall HIV positivity rate was 43.1%. HIV rates were higher among patients with HSV (62.5%, p = 0.07, Chi Square Test) and TP (87.5%, p < 0.01, Fisher's Exact Test). Conclusions: Genital herpes was the most common cause of GUD in our survey, followed by primary syphilis. The association of HIV infection with HSV and TP suggests high risk for co-transmission; however some HSV ulcerations among HIV-infected patients may be the result of HSV reactivation among immunocompromised patients. Our study methods and data should be relevant for other countries using a syndromic management to STI control.