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Changes in the etiology of sexually transmitted diseases in Botswana between 1993 and 2002: implications for the clinical management of genital ulcer disease.
Clin Infect Dis. 2005 Nov 01; 41(9):1304-12.CI

Abstract

BACKGROUND

In recent years, increasing evidence has accumulated that suggests the majority of cases of genital ulcer disease in sub-Saharan Africa are due to viral and not bacterial infections. Although many cross-sectional studies support such a trend, few serial cross-sectional data are available to show the evolution of genital ulcer disease over time.

METHODS

We surveyed the prevalence of sexually transmitted diseases (STDs) among patients with STD symptoms and women recruited from family planning clinics in 3 cities in Botswana in 2002 and compared our findings with those from a survey of a similar population conducted in 1993.

RESULTS

The observed proportion of cases of genital ulcer disease due to chancroid decreased from 25% in 1993 to 1% in 2002, whereas the proportion of ulcers due to herpes simplex virus increased from 23% in 1993 to 58% in 2002. Although the proportion of ulcers due to syphilis was similar for both surveys, the rate of positive serologic test results for syphilis among patients with genital ulcer disease decreased from 52% in 1993 to 5% in 2002. During this period, decreases in the prevalence of gonorrhea, syphilis-reactive serologic findings, chlamydial infection, and trichomoniasis were also detected among patients with STDs and women from family planning clinics. These changes remained significant after estimates were adjusted for the sensitivity and specificity of diagnostic tests.

CONCLUSIONS

Our findings suggest a decrease in the prevalence of bacterial STDs and trichomoniasis, a reduction in the proportion of ulcers due to bacterial causes, and an increase in the proportion of ulcers due to herpes simplex virus during the period 1993-2002. These changes should be taken into consideration when defining new guidelines for the syndromic management of genital ulcer disease.

Authors+Show Affiliations

National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. gpbz@cdc.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16206106

Citation

Paz-Bailey, Gabriela, et al. "Changes in the Etiology of Sexually Transmitted Diseases in Botswana Between 1993 and 2002: Implications for the Clinical Management of Genital Ulcer Disease." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 41, no. 9, 2005, pp. 1304-12.
Paz-Bailey G, Rahman M, Chen C, et al. Changes in the etiology of sexually transmitted diseases in Botswana between 1993 and 2002: implications for the clinical management of genital ulcer disease. Clin Infect Dis. 2005;41(9):1304-12.
Paz-Bailey, G., Rahman, M., Chen, C., Ballard, R., Moffat, H. J., Kenyon, T., Kilmarx, P. H., Totten, P. A., Astete, S., Boily, M. C., & Ryan, C. (2005). Changes in the etiology of sexually transmitted diseases in Botswana between 1993 and 2002: implications for the clinical management of genital ulcer disease. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 41(9), 1304-12.
Paz-Bailey G, et al. Changes in the Etiology of Sexually Transmitted Diseases in Botswana Between 1993 and 2002: Implications for the Clinical Management of Genital Ulcer Disease. Clin Infect Dis. 2005 Nov 1;41(9):1304-12. PubMed PMID: 16206106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in the etiology of sexually transmitted diseases in Botswana between 1993 and 2002: implications for the clinical management of genital ulcer disease. AU - Paz-Bailey,Gabriela, AU - Rahman,Mafiz, AU - Chen,Cheng, AU - Ballard,Ronald, AU - Moffat,Howard J, AU - Kenyon,Tom, AU - Kilmarx,Peter H, AU - Totten,Patricia A, AU - Astete,Sabina, AU - Boily,Marie Claude, AU - Ryan,Caroline, Y1 - 2005/10/04/ PY - 2005/01/14/received PY - 2005/05/30/accepted PY - 2005/10/6/pubmed PY - 2006/7/14/medline PY - 2005/10/6/entrez SP - 1304 EP - 12 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 41 IS - 9 N2 - BACKGROUND: In recent years, increasing evidence has accumulated that suggests the majority of cases of genital ulcer disease in sub-Saharan Africa are due to viral and not bacterial infections. Although many cross-sectional studies support such a trend, few serial cross-sectional data are available to show the evolution of genital ulcer disease over time. METHODS: We surveyed the prevalence of sexually transmitted diseases (STDs) among patients with STD symptoms and women recruited from family planning clinics in 3 cities in Botswana in 2002 and compared our findings with those from a survey of a similar population conducted in 1993. RESULTS: The observed proportion of cases of genital ulcer disease due to chancroid decreased from 25% in 1993 to 1% in 2002, whereas the proportion of ulcers due to herpes simplex virus increased from 23% in 1993 to 58% in 2002. Although the proportion of ulcers due to syphilis was similar for both surveys, the rate of positive serologic test results for syphilis among patients with genital ulcer disease decreased from 52% in 1993 to 5% in 2002. During this period, decreases in the prevalence of gonorrhea, syphilis-reactive serologic findings, chlamydial infection, and trichomoniasis were also detected among patients with STDs and women from family planning clinics. These changes remained significant after estimates were adjusted for the sensitivity and specificity of diagnostic tests. CONCLUSIONS: Our findings suggest a decrease in the prevalence of bacterial STDs and trichomoniasis, a reduction in the proportion of ulcers due to bacterial causes, and an increase in the proportion of ulcers due to herpes simplex virus during the period 1993-2002. These changes should be taken into consideration when defining new guidelines for the syndromic management of genital ulcer disease. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/16206106/Changes_in_the_etiology_of_sexually_transmitted_diseases_in_Botswana_between_1993_and_2002:_implications_for_the_clinical_management_of_genital_ulcer_disease_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/496979 DB - PRIME DP - Unbound Medicine ER -