ArticleThe Journal of infectious diseases2012
Symptomatic vaginal discharge is a poor predictor of sexually transmitted infections and genital tract inflammation in high-risk women in South Africa.
Article in The Journal of infectious diseases, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 128 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
128 citing papers in PubMed, 3 syntheses or guidelines pooled it, 210 citations in OpenAlex.
- Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward.Journal of the International AIDS Society · 2019Pooled it
- Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis.The Lancet. Infectious diseases · 2017Pooled it
- Pooled it
- Youth-Friendly Sexual Health Services and Peer Support for Improved Sexual and Reproductive Health Outcomes Among Adolescents and Young Adults in South Africa: Results of a Factorial Randomized Controlled Trial.Sexually transmitted diseases · 2025Trial
- Probiotics reduce the recurrence of asymptomatic bacterial vaginosis in Chinese women.Scientific reports · 2025Trial
- Investigating the effects of cytokine biomarkers on HIV incidence: a case study for individuals randomized to pre-exposure prophylaxis vs. control.Frontiers in public health · 2024Trial
- Impact of Point-of-Care Testing on the Management of Sexually Transmitted Infections in South Africa: Evidence from the HVTN702 Human Immunodeficiency Virus Vaccine Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- Trial
- Genital inflammatory status and the innate immune response to contraceptive initiation.American journal of reproductive immunology (New York, N.Y. : 1989) · 2022Trial
- Higher mucosal antibody concentrations in women with genital tract inflammation.Scientific reports · 2021Trial
- ProbioticFrontiers in cellular and infection microbiology · 2021Trial
- Cervicovaginal Immune Activation in Zambian Women With Female Genital Schistosomiasis.Frontiers in immunology · 2021Trial
- Testing the regulatory framework in South Africa - a single-blind randomized pilot trial of commercial probiotic supplementation to standard therapy in women with bacterial vaginosis.BMC infectious diseases · 2020Trial
- Exploring potential of vaginal Lactobacillus isolates from South African women for enhancing treatment for bacterial vaginosis.PLoS pathogens · 2020Trial
- An exploratory pilot study evaluating the supplementation of standard antibiotic therapy with probiotic lactobacilli in south African women with bacterial vaginosis.BMC infectious diseases · 2019Trial
- Patterns of prevalent HPV and STI co-infections and associated factors among HIV-negative young Western Cape, South African women: the EVRI trial.Sexually transmitted infections · 2018Trial
- Risk Factors for Incidence of Sexually Transmitted Infections Among Women in a Human Immunodeficiency Virus Chemoprevention Trial: VOICE (MTN-003).Sexually transmitted diseases · 2017Trial
- Biological factors that place women at risk for HIV: evidence from a large-scale clinical trial in Durban.BMC women's health · 2016Trial
- Soluble Immune Mediators and Vaginal Bacteria Impact Innate Genital Mucosal Antimicrobial Activity in Young Women.American journal of reproductive immunology (New York, N.Y. : 1989) · 2015Trial
- Lower concentrations of chemotactic cytokines and soluble innate factors in the lower female genital tract associated with the use of injectable hormonal contraceptive.Journal of reproductive immunology · 2015Trial
68 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
13 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundDiagnosis and treatment of sexually transmitted infections (STIs) is a public health priority, particularly in regions where the incidence of human immunodeficiency virus (HIV) infection is high. In most developing countries, STIs are managed syndromically. We assessed the adequacy of syndromic diagnosis of STIs, compared with laboratory diagnosis of STIs, and evaluated the association between STI diagnosis and the risk of HIV acquisition in a cohort of high-risk women.
methodsHIV-uninfected high-risk women (n = 242) were followed for 24 months. Symptoms of STIs were recorded, and laboratory diagnosis of common STI pathogens was conducted every 6 months. Forty-two cytokines were measured by Luminex in cervicovaginal lavage specimens at enrollment. Human immunodeficiency virus type 1 (HIV-1) infection was evaluated monthly.
resultsOnly 12.3% of women (25 of 204) who had a laboratory-diagnosed, discharge-causing STI had clinically evident discharge. Vaginal discharge was thus a poor predictor of laboratory-diagnosed STIs (sensitivity, 12.3%; specificity, 93.8%). Cervicovaginal cytokine concentrations did not differ between women with asymptomatic STIs and those with symptomatic STIs and were elevated in women with asymptomatic STIs, compared with women with no STIs or bacterial vaginosis. Although laboratory-diagnosed STIs were associated with increased risk of HIV infection (hazard ratio, 3.3 [95% confidence interval, 1.5-7.2)], clinical symptoms were not.
conclusionsSyndromic STI diagnosis dependent on vaginal discharge was poorly predictive of laboratory-diagnosed STI. Laboratory-diagnosed STIs were associated with increased susceptibility to HIV acquisition, while vaginal discharge was not.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.