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More Mungati: MBChB, MPH Zimbabwe Ministry of Health and Child Care

Prevalence of Chlamydia and Gonorrhea Among Patients With Genital Ulcer Disease in Zimbabwe: Potential Implications for Syndromic Management. More Mungati: MBChB, MPH Zimbabwe Ministry of Health and Child Care University of Zimbabwe, Department of Community Medicine. Introduction.

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More Mungati: MBChB, MPH Zimbabwe Ministry of Health and Child Care

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  1. Prevalence of Chlamydia and Gonorrhea Among Patients With Genital Ulcer Disease in Zimbabwe:Potential Implications for Syndromic Management More Mungati: MBChB, MPH Zimbabwe Ministry of Health and Child Care University of Zimbabwe, Department of Community Medicine

  2. Introduction • Laboratory testing for Sexually Transmitted Infections (STIs) is not routinely available in Zimbabwe • Therefore syndromic approach used in Zimbabwe and other developing countries • Surveillance and sentinel lab testing are vital for developing treatment guidelines

  3. Introduction • Syndromic treatment for genital ulcer disease (GUD) includes • Benzathine penicillin, erythromycin, and acyclovir • Patients with co-existent gonorrhoea or chlamydia infections are not adequately treated unless they have concomitant genital discharge • Chlamydia and gonorrhoea are frequently asymptomatic • CT in women (70%) and men (30%) • NG in women (80%) and men (10%)

  4. Introduction • How common are chlamydia and/or gonorrhoea infections in patients with GUD? • What is the likelihood that these patients are not treated for these co-infections when using the syndromic approach?

  5. Methods • This study was part of a larger cross sectional study to determine the etiology of STI syndromes in Zimbabwe • Men with urethral discharge (n=200) • Women with vaginal discharge (n=200) • Men and women with genital ulcer disease (n=200)

  6. Results

  7. Results • Enrollment completed, 600 enrolled • Of 100 men and 100 women with GUD • Full results available for 100 women and 98 men • Specimens for 2 men inadequate

  8. Aetiology of Genital Ulcer Disease, Zimbabwe: 2014-2015

  9. Prevalence of Gonorrhoea and Chlamydia among Different Syndromes, Zimbabwe: 2014-2015

  10. Infection with Gonorrhoea and/or Chlamydia, Zimbabwe: 2014-2015

  11. Eligibility for Simultaneous Genital Discharge Syndrome Management, Zimbabwe: 2014-2015

  12. Results • Of the 52 men and women with GUD who were co-infected with chlamydia and gonorrhoea 36 (69%) were not eligible for genital discharge syndrome management • This represents 18.2% of all patients with GUD in our study

  13. Discussion • Syndromic management of STIs effectively • Treats symptomatic patients • Treats mixed infections • Avoids expensive tests • High prevalence of CT/NG in asymptomatic patients • 31-100% (Detels et al 2011); • Causes PID, subfertility 8.7% (Nwankwo et al 2014) • Prevalence of CT/NG in women with vaginal discharge is similar to men/women with GUD

  14. Limitations • Only patients with symptomatic STIs studied • Possible over-sampling of high risk patients

  15. Conclusions • Gonococcal and chlamydia infections present in 26% of GUD cases. • 69% would not have been treated • Results raises concerns on the syndromic approach for genital ulcer disease

  16. Next Steps • So what are the alternatives: • Ignore this high prevalence of CT/NG among patients with GUD? • Screen all patients with GUD for chlamydia and gonorrhoea? • Treat all patients with GUD for chlamydia and gonorrhoea?

  17. Zimbabwe STI Aetiology StudyResearch Team • DCM/SEAM/ZiCHIRE • Prof. Mufuta Tshimanga • Dr. Gerald Shambira • Mr. Vitalis Kupara • Ms. Luanne Rodgers • Ministry of Health and Child Care • Dr. Owen Mugurungi • Dr. More Mungati • Ms. Anna Machiha • Mr. Justice Nyakura • U.S. Centers for Disease Control and Prevention • Dr. Peter Kilmarx • Ms. Elizabeth Gonese • Dr. Amy Herman-Roloff • Consultants • Prof. David Lewis • University of Sydney, Western Sydney Sexual Health • Prof. Hunter Handsfield • University of Washington • Prof. Kees Rietmeijer • Rietmeijer Consulting, USA

  18. Collaboration • Zimbabwe Ministry of Health and Child Care • University of Zimbabwe, Department of Community Medicine • Centers for Disease Control and Prevention

  19. Funding This project has been supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through Cooperative Agreement between the Centers for Disease Control and Prevention and the University of Zimbabwe Department of Community Medicine SEAM Project under the terms of Cooperative Agreement Number:  1U2GGH000315-01

  20. Thank You

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