Article

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

Department of Medicine , University of Washington Seattle, Seattle, Washington, United States
Clinical Infectious Diseases (Impact Factor: 8.89). 12/2005; 41(9):1304-12. DOI: 10.1086/496979
Source: PubMed

ABSTRACT

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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    • "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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    • "The low level of serologically active syphilis confirms the low incidence of this previously common pathogen in west and central Africa, and is supported by the absence of detectable lesional T. pallidum in this study. We found a high proportion (45%) of 'unknown' GUD aetiologies, higher than in previous studies (25–35%)2324252627. This cannot be readily ascribed to the detection methods that were very sensitive and undertaken repeatedly. "
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