BibTex format
@article{Michalow:2024:10.1371/journal.pmed.1004385,
author = {Michalow, J and Walters, MK and Edun, O and Wybrant, M and Davies, B and Kufa, T and Mathega, T and Chabata, ST and Cowan, FM and Cori, A and Boily, M-C and Imai-Eaton, JW},
doi = {10.1371/journal.pmed.1004385},
journal = {PLoS Medicine},
title = {Aetiology of vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa: a systematic review and meta-regression},
url = {http://dx.doi.org/10.1371/journal.pmed.1004385},
volume = {21},
year = {2024}
}
RIS format (EndNote, RefMan)
TY - JOUR
AB - BACKGROUND: Syndromic management is widely used to treat symptomatic sexually transmitted infections in settings without aetiologic diagnostics. However, underlying aetiologies and consequent treatment suitability are uncertain without regular assessment. This systematic review estimated the distribution, trends, and determinants of aetiologies for vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa (SSA). METHODS AND FINDINGS: We searched Embase, MEDLINE, Global Health, Web of Science, and grey literature from inception until December 20, 2023, for observational studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance, used generalised linear mixed-effects meta-regressions to generate estimates, and critically appraised studies using an adapted Joanna Briggs Institute checklist. Of 4,418 identified records, 206 reports were included from 190 studies in 32 countries conducted between 1969 and 2022. In 2015, estimated primary aetiologies for vaginal discharge were candidiasis (69.4% [95% confidence interval (CI): 44.3% to 86.6%], n = 50), bacterial vaginosis (50.0% [95% CI: 32.3% to 67.8%], n = 39), chlamydia (16.2% [95% CI: 8.6% to 28.5%], n = 50), and trichomoniasis (12.9% [95% CI: 7.7% to 20.7%], n = 80); for urethral discharge were gonorrhoea (77.1% [95% CI: 68.1% to 84.1%], n = 68) and chlamydia (21.9% [95% CI: 15.4% to 30.3%], n = 48); and for genital ulcer were herpes simplex virus type 2 (HSV-2) (48.3% [95% CI: 32.9% to 64.1%], n = 47) and syphilis (9.3% [95% CI: 6.4% to 13.4%], n = 117). Temporal variation was substantial, particularly for genital ulcer where HSV-2 replaced chancroid as the primary cause. Aetiologic distributions for each symptom were largely the same across regions and population strata, despite HIV status and age being significantly associated with several infection diagnoses. Limitations of the review include the absence of studies in 1
AU - Michalow,J
AU - Walters,MK
AU - Edun,O
AU - Wybrant,M
AU - Davies,B
AU - Kufa,T
AU - Mathega,T
AU - Chabata,ST
AU - Cowan,FM
AU - Cori,A
AU - Boily,M-C
AU - Imai-Eaton,JW
DO - 10.1371/journal.pmed.1004385
PY - 2024///
SN - 1549-1277
TI - Aetiology of vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa: a systematic review and meta-regression
T2 - PLoS Medicine
UR - http://dx.doi.org/10.1371/journal.pmed.1004385
UR - https://www.ncbi.nlm.nih.gov/pubmed/38768094
UR - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004385
VL - 21
ER -