High burden of asymptomatic genital tract infections among sexually active South African youth
1. Title: High burden of asymptomatic genital tract infections among sexually active
South African youth: Considerations for HIV prevention programs
Authors: A. Kaida1
, J. Dietrich2
, S. Hornschuh2
, F. Laher2
, K. Otw ombe2
, E. Lazarus2
, N.
Hunt2
, M. Beksinska3
, T. Mathenjw a3
, M. Jaggernath3
, R. Greener3
, M. Bardsley6
, D.
Lew is4
, V. Maseko4
, P. Smith1
, L. Cotton1
, J. Smit3
, T. Ndung'u5
, G. Gray2
, M.
Brockman1
Institution(s): 1
Simon Fraser University, Faculty of Health Sciences, Vancouver,
Canada, 2
Perinatal HIV Research Unit (PHRU), University of the Witwatersrand,
Faculty of Health Sciences, Johannesburg, South Africa,3
Maternal Adolescent and
Child Health (MatCH) Research Unit, University of the Witwatersrand, Faculty of
Health Sciences, Durban, South Africa, 4
Centre for HIV and STIs, National Institute
for Communicable Diseases, Johannesburg, South Africa, 5
HIV Pathogenesis
Programme and KwaZulu-Natal Research Institute for TB and HIV, University of
KwaZulu-Natal, Durban, South Africa, 6
Faculty of Public Health and Policy and the
Faculty of Infectious Tropical Diseases, The London School of Hygiene and Tropical
Medicine, London, United Kingdom
Untreated genital tract infections (GTIs) increase HIV risk. South African GTI treatment guidelines
employ syndromic management, which may underestimate cases. We compared GTIprevalence
by symptom-based and laboratory assessmentamong youth, stratified by sex.
We analysed baseline data from youth (aged 16-24) residing in Soweto or Durban, who reported
HIV-negative or unknown status at enrolment(Nov 2014-May 2016). Interviewer-administered
surveys assessed demographics, behaviours, and sex-specific GTI symptoms. Laboratory tests
assessed HIV-1, Chlamydia trachomatis, Neisseria gonorrhoea, Trichomonas vaginalis,
Mycoplasma genitalium and, among females only, bacterial vaginosis (BV) and Candida. Genital
ulcers were tested for herpes simplex virus (HSV-2) and Treponema pallidum.
Among 361 sexually-experienced youth (57% female, median age 19, 7% LGBTQ), 55% self-
perceived as low/no risk ofHIV although 22% offemales and 75% ofmales reported ≥2 sexual
partners in the last 6 months (p<0.001) and 80% of females and 51% ofmales reported
inconsistentcondom use (p<0.001).
Overall, 34/207 (16%) females reported ≥1 GTI symptom, primarily vaginal discharge (n=15). Just
1/141 (0.7%) male reported any GTI symptom (urethral discharge).In contrast, clinical tests
identified ≥1 GTI in 139 (67%) females and 16 (10%) males. Female BV prevalence was 53.0%,
chlamydia 18.1%, candidiasis 9.6%, M genitalium 9.6%, trichomoniasis 8.5%, gonorrhoea 7.0%,
and HIV 4.8%. Male chlamydia prevalence was 7.8%, M genitalium 3.3%, trichomoniasis <1%,
gonorrhoea 1.3% and HIV 2.0%. 1 female case ofherpes was identified (0 syphilis). Overall, 22%
of females and 0% of males with confirmed GTI (excluding HIV) reported GTI symptoms.
GTI infections in youth are frequently asymptomatic, hence syndromic GTImanagementis
suboptimal for this population. There is an urgent need for linked biomedical and structural youth
HIV prevention modalities,resourced to incorporate laboratory-based GTI services.
