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. 2022 Aug 1;49(8):565-570.
doi: 10.1097/OLQ.0000000000001646. Epub 2022 May 13.

Etiological Surveillance of Vaginal Discharge Syndrome in South Africa: 2019 to 2020

Ranmini Kularatne, Etienne Muller  1 , Venessa Maseko  1 , Bianca Da Costa Dias  1 , Tendesayi Kufa
Affiliations

Etiological Surveillance of Vaginal Discharge Syndrome in South Africa: 2019 to 2020

Ranmini Kularatne et al. Sex Transm Dis. .

Abstract

Background: The syndromic management of vaginal discharge syndrome (VDS) is challenging because of the prevalence of mixed infection with sexually transmitted infection (STI) pathogens and non-STI causes, such as bacterial vaginosis and candidiasis (CA). We aimed to determine the relative prevalence of VDS etiologies in women presenting to sentinel primary health care clinics in South Africa. Secondary objectives were to ascertain the predictive value of speculum findings for the presence of STI pathogens and the proportion of women presenting with clinical features of CA who had identifiable yeast on vaginal smear microscopy.

Methods: Consecutive, consenting women with complaints of abnormal vaginal discharge were enrolled between January 1, 2019, and December 31, 2020. Genital discharge swab and blood specimens were collected and transported to a central STI reference laboratory in Johannesburg.

Results: A total of 364 women were enrolled at 3 sentinel sites. Bacterial vaginosis was the most common cause of VDS (163 of 361 [45.2%]; 95% confidence interval [CI], 40.1%-50.3%); however, a significant proportion had STI coinfection (71 of 163 [43.6%]; 95% CI, 35.8%-51.5%). The predominant STI etiology was Chlamydia trachomatis (73 [20.2%]; 95% CI, 16.4%-24.7%). An abnormal speculum finding had poor predictive value for STIs, and Gram stain microscopy showed yeast in only 37.2% of vaginal smears from women with CA symptoms.

Conclusions: Bacterial vaginosis is the predominant cause of VDS in South Africa; however, STI coinfection is common. Clinical findings are poorly predictive of STI etiologies or candidiasis; therefore, a rapid and accurate STI point-of-care test would be useful in optimizing VDS management.

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Conflict of interest statement

Conflict of Interest and Source of Funding: All authors have no conflicts of interest to declare. Funding for this work was obtained from the operational cost center of the Centre for HIV & STI at the National Institute for Communicable Diseases, South Africa.

References

    1. Guidelines for the Management of Symptomatic Sexually Transmitted Infections. Geneva, Switzerland: World Health Organization, 2021. Licence: CC BY-NC-SA 3.0 IGO.
    1. Kularatne R, Radebe F, Kufa-Chakezha T, et al. Sentinel Surveillance of Sexually Transmitted Infection Syndrome Aetiologies and HPV Genotypes Among Patients Attending Primary Healthcare Facilities in South Africa, April 2014–September 2015. Johannesburg, South Africa: National Institute for Communicable Diseases; Centre for HIV & STIs, 2017.
    1. Sexually Transmitted Infections Management Guidelines. Pretoria, South Africa: National Department of Health, 2015.
    1. Kufa T, Gumede L, Maseko DV, et al. The demographic and clinical profiles of women presenting with vaginal discharge syndrome at primary care facilities in South Africa: Associations with age and implications for management. S Afr Med J 2018; 108:876–880.
    1. Primary Healthcare Standard Treatment Guideline and Essential Medicine List. 6th ed. Pretoria, Republic of South Africa: National Department of Health, 2018.

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