Abstract:
In Mozambique, sexually transmitted infections (STIs) are estimated to be
prevalent, but diagnosis and treatment of curable STIs rely only on syndromic
management. We examined the prevalence of four non-viral STIs and HIV-1/2,
based on etiological diagnosis, associations with sociodemographic and
behavioural factors, and the STI diagnostic accuracy of the vaginal discharge
syndromic management in women with urogenital complaints in Maputo,
Mozambique. A cross-sectional study was performed in Maputo, Mozambique,
February 2018–January 2019, enrolling 924 women of reproductive age with
urogenital complaints. Endocervical/vaginal swabs were sampled and
chlamydia, gonorrhoea, trichomoniasis and Mycoplasma genitalium infections
were diagnosed using a multiplex real-time PCR (AmpliSens; InterLabServices).
Serological testing was performed for HIV-1/2. A structured questionnaire
collected metadata. All data were analyzed in STATA/IC 12.1 using descriptive
statistics, chi-square tests and logistic regression model. About 40% of the
women were less than 24 years old, 50.8% were single, 62.1% had their sexual
debut between 12 and 17 years of age, and the main complaint was vaginal
discharge syndrome (85%). The prevalence of chlamydia was 15.5%,
trichomoniasis 12.1%, gonorrhoea 4.0%, M. genitalium 2.1%, and HIV-1/2
22.3%. The vaginal discharge syndrome flowchart had a sensitivity of
73.0%–82.5% and a specificity of 14%–15% for the detection of any individual
non-viral STI in women with urogenital complaints. In total, 19.2% of the
symptomatic women with chlamydia, trichomoniasis or gonorrhoea would not
be detected and accordingly treated using the vaginal discharge syndromic
management (missed treatment) and 70.0% of the women would be treated despite not being infected with any of these three STIs (overtreatment). In
conclusion, a high prevalence of especially chlamydia, trichomoniasis, and
HIV-1/2 was found in women of childbearing age with urogenital complaints in
Maputo, Mozambique. Syndromic management of vaginal discharge revealed
low accuracy in the detection of STIs in symptomatic women, especially low
specificity, which resulted in under-treatment of STI-positive cases and
incorrect or over-treatment of women with urogenital complaints, many of
whom were negative for all the non-viral STIs. Etiological diagnosis is imperative
for effective management of STIs in symptomatic and asymptomatic women.
