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Int J STD AIDS. 2018 May;29(6):531-539. doi: 10.1177/0956462417740487. Epub 2017 Dec 4.

Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV.

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1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
2 Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
3 National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
4 DST-NRF CAPRISA Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa.
5 145793 Seattle Children's Research Institute , University of Washington, Seattle, WA, USA.
6 Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia.
7 Centre for Infectious Diseases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, Australia.
8 Centre for HIV and STIs, 70687 National Institute for Communicable Disease , National Health Laboratory Service, Johannesburg, South Africa.
9 SAMRC/UCT Gynaecological Cancer Research Centre Center for HIV and STIs, Cape Town, South Africa.
10 Northwestern University, Chicago, USA.
11 Karolinska Institute, Stockholm, Sweden.
12 Perinatal HIV Research Unit, Faculty of Health Sciences, 196579 University of the Witwatersrand , Diepkloof, Johannesburg, South Africa.
13 59097 South African Medical Research Council , Cape Town, South Africa.


Adolescents in Africa are at high risk for HIV infection, other sexually transmitted infections (STIs) and bacterial vaginosis (BV). Since behavior and burden of STIs/BV may influence HIV risk, behavioral risk factors and prevalence of STIs/BV were compared in HIV-seronegative adolescent females (n = 298; 16-22 years) from two South African communities (Soweto and Cape Town). STIs ( Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, herpes simplex virus (HSV)-1, HSV-2, Treponema pallidum, and Haemophilus ducreyi) were detected by multiplex polymerase chain reaction, human papillomavirus (HPV) by Roche Linear Array, and BV by Nugent scoring. Rates of BV (Nugent ≥7; 46.6%) and HPV (66.8%) were high in both communities. Prevalence of C. trachomatis and N. gonorrhoeae were >2-fold higher in Cape Town than Soweto (Chlamydia: 42% [62/149] versus 18% [26/148], p < 0.0001; gonorrhoea 11% [17/149] versus 5% [7/148], p = 0.05). Only 24% of adolescents with vaginal discharge-causing STIs or BV were symptomatic. In South African adolescents, clinical symptoms compatible with vaginal discharge syndrome had a sensitivity of 23% and specificity of 85% for the diagnosis of discharge-causing STI or BV. In a region with high HIV prevalence and incidence, >70% of young women with treatable conditions that could enhance HIV risk would have been missed because they lacked symptoms associated with syndromic management.


Female; adolescents; bacterial vaginosis; sexually transmitted infections; syndromic management

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