Changes in the Etiology of Sexually Transmitted Diseases in Botswana between 1993 and 2002: Implications for the Clinical Management of Genital Ulcer Disease

National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 12/2005; 41(9):1304-12. DOI: 10.1086/496979
Source: PubMed


In recent years, increasing evidence has accumulated that suggests the majority of cases of genital ulcer disease in sub-Saharan Africa are due to viral and not bacterial infections. Although many cross-sectional studies support such a trend, few serial cross-sectional data are available to show the evolution of genital ulcer disease over time.
We surveyed the prevalence of sexually transmitted diseases (STDs) among patients with STD symptoms and women recruited from family planning clinics in 3 cities in Botswana in 2002 and compared our findings with those from a survey of a similar population conducted in 1993.
The observed proportion of cases of genital ulcer disease due to chancroid decreased from 25% in 1993 to 1% in 2002, whereas the proportion of ulcers due to herpes simplex virus increased from 23% in 1993 to 58% in 2002. Although the proportion of ulcers due to syphilis was similar for both surveys, the rate of positive serologic test results for syphilis among patients with genital ulcer disease decreased from 52% in 1993 to 5% in 2002. During this period, decreases in the prevalence of gonorrhea, syphilis-reactive serologic findings, chlamydial infection, and trichomoniasis were also detected among patients with STDs and women from family planning clinics. These changes remained significant after estimates were adjusted for the sensitivity and specificity of diagnostic tests.
Our findings suggest a decrease in the prevalence of bacterial STDs and trichomoniasis, a reduction in the proportion of ulcers due to bacterial causes, and an increase in the proportion of ulcers due to herpes simplex virus during the period 1993-2002. These changes should be taken into consideration when defining new guidelines for the syndromic management of genital ulcer disease.

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    • "Seroprevalence in women is up to twice as high as men, and increases with age [3] [6]. Although HSV-2 is the leading cause of genital ulcer disease (GUD) worldwide [7] [8], most people are unaware of having the infection [9]. HSV-2 transmission occurs through genital-genital contact during sexual activity. "
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    ABSTRACT: Herpes simplex virus type 2 (HSV-2) infects 530million people, is the leading cause of genital ulcer disease, and increases the risk of HIV-1 acquisition. Although several candidate vaccines have been promising in animal models, prophylactic and therapeutic vaccines have not been effective in clinical trials thus far. Negative results from the most recent prophylactic glycoprotein D2 subunit vaccine trial suggest that we must reevaluate our approach to HSV-2 vaccine development. We discuss HSV-2 pathogenesis, immunity, and vaccine efforts to date, as well as the current pipeline of candidate vaccines and design of trials to evaluate new vaccine constructs.
    Vaccine 09/2013; 32(14). DOI:10.1016/j.vaccine.2013.08.066 · 3.62 Impact Factor
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    • "In Botswana, the Ministry of Health (MOH) reviews and updates its national syndromic management protocols based on periodic aetiological studies and other developments in healthcare.9–11 A study performed in 2002 that used highly sensitive diagnostic assays demonstrated a high prevalence of HIV among patients seeking care for STI-related complaints relative to a sentinel HIV prevalence of 38.6% among pregnant women in Botswana in 2001.12 "
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    ABSTRACT: In 2004, the Ministry of Health adopted revised protocols for the syndromic management of sexually transmitted infections (STI) that included routine HIV testing. A training programme for providers was developed on the revised protocols that featured interactive case studies and training videos. An objective of the first phase of the training programme was to test its effect on four measures of clinical practice: (1) routine HIV testing; (2) performance of physical examination; (3) risk-reduction counselling and (4) patient education. Clinical practice in a district where providers were trained was compared with a district without training. The measures of clinical practice were reported by 185 patients of providers who had been trained and compared with reports by 124 patients at comparison clinics. Relative to patients at comparison clinics, a higher percentage of patients of trainees reported that the provider: (1) offered an HIV test (87% versus 29%; p<0.001); (2) conducted a physical examination (98% versus 64%; p<0.001); (3) helped them to make a plan to avoid future STI acquisition (95% versus 76%; p<0.001) and (4) provided patient-specific information about HIV risk (65% versus 32%; p<0.001). Among patients offered HIV testing, the percentage who accepted did not differ between groups (38% of 161 patients of trainees versus 50% of 36 comparison patients; p = 0.260). Overall, 33% of patients of trainees and 14% of comparison patients were tested (p<0.001). A multifaceted training programme was associated with higher rates of HIV testing, physical examination, risk-reduction counselling and better HIV risk education.
    Sexually transmitted infections 02/2008; 84(4):259-64. DOI:10.1136/sti.2007.028217 · 3.40 Impact Factor
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    ABSTRACT: In developing countries, data about the prevalence of genital Chlamydia trachomatis infections and their sequelae, tubal infertility and premature rupture of membrane is scarce. A prospective case-control study was performed enrolling 491 Ghanaian women. The first case group included 191 patients with primary or secondary infertility, the second case group included 52 pregnant women with premature rupture of membrane. The control group consisted of 248 healthy pregnant women. First-void urine samples were investigated by PCR, and serum specimens were tested for C. trachomatis-specific IgG and IgA antibodies. Demographic and behavioral information were gathered for statistical analysis. The PCR prevalence of C. trachomatis was relatively low and did not differ significantly among all groups (2.4 versus 1.6 % versus 1,9 %). In contrast, significantly higher prevalences of specific IgG (39 % versus 19 %) and IgA (14 % versus 3 %) antibodies were found among infertile women. There were no difference in the prevalences of specific IgG (17 % versus 19 %) and IgA (4 % versus 3 %) between the group of pregnant women with premature rupture of membrance and the control group. Our data suggest that previous C. trachomatis infections may contribute to infertility in Ghanaian women. We could not demonstrate a correlation between a chlamydial infection and a premature rupture of membrance.
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