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1.
PLoS One ; 18(11): e0294285, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37948399

RESUMO

BACKGROUND: South Africa is among the countries with the highest prevalence of sexually transmitted infections (STIs), including Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). In 2017, there were an estimated 6 million new CT, 4.5 million NG and 71 000 Treponema pallidum infections among South African men and women of reproductive age. METHODS: We evaluated STI prevalence and incidence and associated risk factors in 162 women aged 18-33 years old, residing in eThekwini and Tshwane, South Africa who were part of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial. Women were randomised to use depot medroxyprogesterone acetate (n = 53), copper intrauterine device (n = 51), or levonorgestrel (n = 58) implant. Lateral vaginal wall swab samples were collected prior to contraceptive initiation and at months one and three following contraceptive initiation for STI testing. RESULTS: There were no significant differences in STI incidence and prevalence across contraceptive groups. At baseline, 40% had active STIs (CT, NG, Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) or herpes simplex virus-2 shedding across all age groups- 18-21 years (46%), 22-25 years (42%) and 26-33 years (29%). The incidence of STIs during follow-up was exceptionally high (107.9/100 women-years [wy]), with younger women (18-21 years) more likely to acquire CT (75.9/100 wy) compared to 26-33 year olds (17.4/100 wy; p = 0.049). TV incidence was higher in the 26-33 year old group (82.7/100 wy) compared to the 18-21 year olds (8.4/100 wy; p = 0.01). CONCLUSIONS: Although the study participants received extensive counselling on the importance of condom use, this study highlights the high prevalence and incidence of STIs in South African women, especially amongst young women, emphasising the need for better STI screening and management strategies.


Assuntos
Infecções por Chlamydia , Infecções por HIV , Infecções Sexualmente Transmissíveis , Trichomonas vaginalis , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , África do Sul/epidemiologia , Anticoncepcionais , Prevalência , Incidência , Infecções Sexualmente Transmissíveis/prevenção & controle , Chlamydia trachomatis , Neisseria gonorrhoeae , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/diagnóstico
2.
Curr Opin Infect Dis ; 36(1): 49-56, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36753705

RESUMO

PURPOSE OF REVIEW: Point-of-care (POC) testing for sexually transmitted infections (STIs) can provide complementary coverage to existing HIV testing services in LMICs. This review summarizes current and emerging technologies for detecting STIs in LMICs, with an emphasis on women, discharge-causing infections (chlamydia, gonorrhoea, trichomoniasis, and syphilis), true POC, self-testing, ethics, and economic considerations related to equitable access. RECENT FINDINGS: The WHO have recently adapted guidelines for treatment of STIs in women that advise the use of true-POC or near-POC tests to improve case finding. The number of rapid, sensitive, and specific POC diagnostics for STIs has increased significantly over the past 10 years, although adoption of these in low-income and middle-income countries (LMICs) remains limited. Barriers to POC adoption by patients include the cost of tests, the inconvenience of lengthy clinic visits, low perceived risk, stigma, lack of partner notification, and lack of trust in healthcare providers. Lowering the cost of true POC lateral flow devices, interfacing these with digital or eHealth technologies, and enabling self-testing/self-sampling will overcome some of these barriers in LMICs. Ensuring linkage of diagnostic tests to subsequent care remains one of the major concerns about self-testing, irrespective of geography, although available evidence from HIV self-testing suggests that linkage to care is similar to that for facility-based testing. SUMMARY: Increasing access to sensitive STI true POC tests will strengthen reproductive healthcare in LMICs. Although HIV self-testing is demonstrably useful in LMICs, there is an urgent need for randomized trials evaluating the utility and cost-effectiveness of similar tests for other sexually transmitted infections.


Assuntos
Infecções por Chlamydia , Gonorreia , Infecções por HIV , Infecções Sexualmente Transmissíveis , Sífilis , Humanos , Feminino , Sistemas Automatizados de Assistência Junto ao Leito , Autoteste , Infecções Sexualmente Transmissíveis/diagnóstico , Gonorreia/diagnóstico , Infecções por HIV/diagnóstico , Infecções por Chlamydia/diagnóstico
3.
Am J Reprod Immunol ; 88(2): e13542, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35394678

RESUMO

PROBLEM: Data on the effects of contraceptives on female genital tract (FGT) immune mediators are inconsistent, possibly in part due to pre-existing conditions that influence immune mediator changes in response to contraceptive initiation. METHODS: This study included 161 South African women randomised to injectable depot medroxyprogesterone acetate (DMPA-IM), copper intrauterine device (IUD), or levonorgestrel (LNG) implant in the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial. We measured thirteen cytokines and antimicrobial peptides previously associated with HIV acquisition in vaginal swabs using Luminex and ELISA, before, and at 1 and 3 months after contraceptive initiation. Women were grouped according to an overall baseline inflammatory profile. We evaluated modification of the relationships between contraceptives and immune mediators by baseline inflammation, demographic, and clinical factors. RESULTS: Overall, LNG implant and copper IUD initiation were associated with increases in inflammatory cytokines, while no changes were observed following DMPA-IM initiation. However, when stratifying by baseline inflammatory profile, women with low baseline inflammation in all groups experienced significant increases in inflammatory cytokines, while those with a high baseline inflammatory profile experienced no change or decreases in inflammatory cytokines. CONCLUSION: We conclude that pre-contraceptive initiation immune profile modifies the effect of contraceptives on the FGT innate immune response.


Assuntos
Anticoncepcionais Femininos , Infecções por HIV , Anticoncepcionais Femininos/efeitos adversos , Anticoncepcionais Femininos/farmacologia , Citocinas , Feminino , Genitália , Infecções por HIV/epidemiologia , Humanos , Imunidade Inata , Inflamação , Dispositivos Intrauterinos de Cobre/efeitos adversos , Levanogestrel/efeitos adversos , Levanogestrel/farmacologia , Acetato de Medroxiprogesterona/efeitos adversos , Acetato de Medroxiprogesterona/farmacologia
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