Neisseria gonorrhoeae and Chlamydia trachomatis infections in patients attending STD and family planning clinics in Bissau, Guinea-Bissau

Prevalence of and risk factors for curable sexually transmitted infections on Bubaque Island, Guinea Bissau

Objectives

Complications from sexually transmitted infections (STIs) can result in severe morbidity and mortality. To date, no STI population studies have been conducted on the Bijagos Islands, Guinea Bissau. Our objective was to estimate the prevalence of and identify risk factors for Chlamydia trachomatis (Ct), Neisseria gonorrhoea (Ng), Mycoplasma genitalium (Mg), Trichomonas vaginalis (Tv) and Treponema pallidum (Tp) on Bubaque, the most populated island.

Methods

A cross-sectional survey was conducted on the island of Bubaque among people aged 16–49 years. Participants were asked to answer a questionnaire on STI risk factors, to provide urine samples (men and women) and vaginal swabs (women) for PCR testing for Ct, Ng, Mg and Tv, and to provide dry blood spots for Tp particle agglutination assays. Data were analysed to estimate the prevalence of STIs and logistic regression was used to identify risk factors.

Results

In total, 14.9% of participants were found to have a curable STI, with the highest prevalence being observed for Tv (5.9%) followed by Ct (3.8%), Ng (3.8%), Mg (1.9%) and Tp (0.8%). Significant risk factors for having any STI included being female, younger age and concurrent partnership. Having had a previous STI that was optimally treated was a protective factor.

Conclusions

This study demonstrates that there is a considerable burden of STI on the Bijagos Islands, stressing the need for diagnostic testing to facilitate early detection and treatment of these pathogens to stop ongoing transmission. Moreover, these results indicate the need to conduct further research into the STI burden on the Bijagos Islands to help inform and develop a national STI control strategy.

Prevalence of chlamydia trachomatis infection among reproductive age women in sub Saharan Africa: a systematic review and meta-analysis

BACKGROUND

Chlamydia trachomatis is the most common curable sexual transmitted bacterial infection in the world, including Sub-Saharan Africa. There is nil systematic review and meta-analysis on Chlamydia trachomatis infection in Sub-Saharan Africa among reproductive age women. Therefore, this study was carried out to determine the pooled prevalence of chlamydia trachomatis infection in Sub-Saharan Africa among reproductive age women.

METHODS

A comprehensive literature search was conducted from biomedical data bases: Medline, PubMed, EMBASE, Google scholar, HINARI and Cochrane Library using a special index search terms (medical subject headings (MeSH), title and abstract. The Cochrane Q test and I² statistics was used to test heterogeneity and publication bias was assessed using Begg's and Egger's tests. Results were presented in tables, figures and funnel plot. Data were pooled in a meta-analysis using a random effects model.

RESULTS

Twenty-four studies were included in this meta-analysis. There was a high level of heterogeneity among studies. The pooled prevalence of Chlamydia trachomatis infection in Sub-Saharan Africa among reproductive age women was 7.8% (95% CI: 5.6-10.6).

CONCLUSION

This review showed that Chlamydia trachomatis infection is high in Sub-Saharan Africa among reproductive age group women. This evidence suggests that governmental and non-governmental organization shall give attention for primary prevention of this infection. Likewise, in resource limited countries policy makers, stakeholders and health care providers' due attention for Chlamydia trachomatis specific and rapid diagnostic test, treatment in any medical out and in patient clinics for reproductive age women.

Phenotypic and genetic characterisation of bacterial sexually transmitted infections in Bissau, Guinea-Bissau, West Africa: a prospective cohort study

BACKGROUND

Knowledge regarding characteristics and transmission of Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium and antibiotic resistance in N gonorrhoeae in Guinea-Bissau, West Africa, is entirely lacking.

OBJECTIVES

To characterise N gonorrhoeae, C trachomatis and M genitalium samples from Guinea-Bissau and to define bacterial populations, possible transmission chains and for N gonorrhoeae spread of antibiotic-resistant isolates.

DESIGN

Prospective cohort study.

SETTING

Two sexual health and family planning clinics, Bissau, Guinea-Bissau.

PARTICIPANTS

Positive samples from 711 women and 27 men.

MATERIAL AND METHODS

Positive samples for N gonorrhoeae (n=31), C trachomatis (n=60) and M genitalium (n=30) were examined. The gonococcal isolates were characterised with antibiograms, serovar determination and N gonorrhoeae multiantigen sequence typing (NG-MAST). The C trachomatis ompA gene and the M genitalium mgpB gene were sequenced, and phylogenetic analyses were performed.

RESULTS

For N gonorrhoeae, the levels of resistance (intermediate susceptibility) to ciprofloxacin, erythromycin, rifampicin, ampicillin, tetracycline, penicillin G and cefuroxime were 10% (0%), 6% (10%), 13% (10%), 68% (0%), 74% (0%), 68% (16%) and 0% (84%), respectively. All isolates were susceptible to cefixime, ceftriaxone, spectinomycin and azithromycin, and the minimum inhibitory concentrations of kanamycin (range: 8-32 mg/l) and gentamicin (range: 0.75-6 mg/l) were low (no resistance breakpoints exist for these antimicrobials). 19 NG-MAST sequence types (STs) (84% novel STs) were identified. Phylogenetic analysis of the C trachomatis ompA gene revealed genovar G as most prevalent (37%), followed by genovar D (19%). 23 mgpB STs were found among the M genitalium isolates, and 67% of isolates had unique STs.

CONCLUSIONS

The diversity among the sexually transmitted infection (STI) pathogens may be associated with suboptimal diagnostics, contact tracing, case reporting and epidemiological surveillance. In Guinea-Bissau, additional STI studies are vital to estimate the STI burden and form the basis for a national sexual health strategy for prevention, diagnosis and surveillance of STIs.

High prevalence of HIV-1, HIV-2 and other sexually transmitted infections among women attending two sexual health clinics in Bissau, Guinea-Bissau, West Africa

The objective was to examine the prevalence of HIV-1, HIV-2 and 10 other sexually transmitted infections (STIs), and to explore the relationship between HIV and those STIs in women attending two sexual health clinics in Bissau, Guinea-Bissau. In all, 711 women with urogenital problems were included. Clinical examination was performed and HIV-1, HIV-2, human T-cell lymphotropic virus (HTLV)-1, HTLV-2 and syphilis were diagnosed by serology. Trichomonas vaginalis was examined using wet mount microscopy. Cervical samples (and swabs from visible ulcers, if present) were used for polymerase chain reaction (PCR) diagnosis of Chlamydia trachomatis, Mycoplasma genitalium, Haemophilus ducreyi, herpes simplex virus (HSV)-1 and HSV-2, and culture diagnosis of Neisseria gonorrhoeae. The prevalence of HIV-1, HIV-2, and HIV-1 and HIV-2 (dual infection) was 9.5%, 1.8% and 1.1%, respectively. The prevalence of HTLV-1 was 2.8%, HTLV-2 0%, HSV-1 1.4%, HSV-2 7.7%, T. vaginalis 20.4%, syphilis 1.0%, N. gonorrhoeae 1.3%, H. ducreyi 2.7%, M. genitalium 7.7% and C. trachomatis 12.6%. HIV-1 and/or HIV-2 infection was significantly associated with active HSV-2 and HIV-1 was significantly associated with M. genitalium infection. In conclusion, HIV-1 and HIV-2 prevalence was higher compared with previous studies of pregnant women in Guinea-Bissau. The prevalence of co-infection of HIV and other STIs is high. National evidence-based guidelines for the management of STIs in Guinea-Bissau are essential.

Pathogens in maternal blood and fetal cord blood using Q-PCR assay

OBJECTIVE

To evaluate the rates of infection of asymptomatic fetuses and mothers through fetal cord blood and maternal blood examination results.

MATERIALS AND METHODS

Quantitative PCR (Q-PCR) was used to detect pathogens in maternal peripheral blood and fetal cord blood after delivery of term pregnancy at Buddhist Tzu Chi Medical Center, Hualien, between July 2002 and June 2003.

RESULTS

We used Q-PCR to detect pathogens in 29 samples of maternal blood. The maternal hepatitis B virus (HBV) DNA detection rate was 51.72% (15/29); for human cytomegalovirus DNA, the detection rate was 10.34% (3/29) and for Chlamydia trachomatis DNA the detection rate was 3.45% (1/29). No Neisseria gonorrhoeae DNA was detected. Whereas, in 29 samples of paired fetal cord blood, the detection rates were 27.59% (8/29), 10.34% (3/29), and 3.45% (1/29) for HBV DNA, C. trachomatis DNA, and N. gonorrhoeae DNA, respectively. No human cytomegalovirus DNA was detected in fetal cord blood.

CONCLUSION

Our results revealed an unexpectedly high incidence of pathogens in fetal cord blood. Screening for the above pathogens in donor cord blood in cord blood banks using Q-PCR is strongly urged to decrease morbidity and mortality rates in fetal cord blood stem cell transplant recipients.