[Downloaded free from http://www.ijmm.org on Saturday, June 13, 2015, IP: 61.16.135.116]
Indian Journal of Medical Microbiology, (2015) 33(3): 410-412
Brief Communication
Asymptomatic reproductive tract infections/sexually transmitted infections among HIV positive women S Bhattar, *P Bhalla, D Rawat, R Tripathi, R Kaur, K Sardana
Abstract This study aims to highlight the importance of screening all HIV positive women for various reproductive tract infections/sexually transmitted infections (RTIs/STIs) irrespective of symptoms and to determine its occurrence in asymptomatic HIV positive women. Relevant specimens were collected for diagnosis of various RTIs/STIs. STIs were diagnosed in nearly one‑third of the HIV positive asymptomatic patients which is quite high. The national strategy for STIs/RTIs control misses out large number of asymptomatic RTIs/STIs in HIV positive women which is responsible for silently transmitting these infections in the community. So this strategy should be modified to include screening of all HIV positives women irrespective of symptoms of STIs/RTIs. Key words: Asymptomatic, Human immunodeficiency virus (HIV), Reproductive tract infections (RTIs), screening, sexually transmitted infections (STIs)
Introduction Sexually transmitted infections (STIs) are important cofactors that enhance Human immunodeficiency virus (HIV) transmission.[1] HIV‑infected individuals with STI are at greater risk of transmitting HIV than those individuals without STIs.[2] There is also evidence that improved STI control reduces HIV transmission.[1] Under Syndromic case management of reproductive tract infections/sexually transmitted infections (RTIs/STIs), treatment is given only to the symptomatic individuals as it is based on categorization of patients into syndromes on the basis of presenting signs and symptoms.[3] This implies that this strategy misses out patients who are asymptomatic and as a result do not come to the STI clinic. Asymptomatic STIs may function as a hidden reservoir contributing to the ongoing epidemic of symptomatic STIs including HIV. The primary objective of this study was to highlight the importance *Corresponding author (email: ) Department of Microbiology (SB, PB, DR, RK), Department of Obstetrics and Gynaecology (RT), Department of Dermatology and Sexually Transmitted Diseases (KS), Maulana Azad Medical College, Delhi University, New Delhi, India Received: 28-05-2014 Accepted: 13-02-2015 Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.158568
of screening all HIV positive women for various RTIs/STIs irrespective of symptoms and to determine the occurrence of RTIs/STIs in asymptomatic HIV positive women. Materials and Methods This was a cross sectional study conducted prospectively between March 2010 to April 2011 at Integrated Counseling and Testing Centre (ICTC), Department of Microbiology in conjunction with Department of Obstetrics and Gynaecology and Department of Dermatology and STD in a tertiary care centre of northern India. Married women between 18–49 years of age were included in the study while those who were menstruating, pregnant, had received antiretroviral therapy in the past or had received treatment for any RTI in the past 4 weeks were excluded. Cases included 60 HIV positive women, 30 with symptoms (Group A1) and 30 without symptoms of RTI (Group A2). Controls comprised of 60 HIV negative women, 30 with symptoms (Group B1) and 30 without symptoms of RTI (Group B2). All study subjects were recruited in the study following institutional ethical committee clearance. Socio‑demographic data and clinical signs and symptoms were recorded in a proforma after a written informed consent and proper counseling. Each study subject then underwent a general physical, per abdomen, per speculum and per vaginum examination. At recruitment, 5 ml of blood was collected in plain vacutainer for HIV testing, syphilis serology and detection of Herpes simplex virus (HSV) antibody. High vaginal swabs were collected during per speculum examination for diagnosis of bacteria vaginosis (BV), trichomoniasis and candidiasis. Two endocervical swabs were collected for detection of Neisseria gonorrhea (Ng) and Chlamydia trachomatis (CT) infection.
[Downloaded free from http://www.ijmm.org on Saturday, June 13, 2015, IP: 61.16.135.116]
July-September 2015
Bhattar, et al.: Aymptomatic RTIs/STIs among HIV positive women
Diagnosis of HIV infection was done by following the standard protocol at our ICTC. For diagonosis of syphilis serum sample were screened for cardiolipin antibodies by Veneral Disease Research Laboratory test (VDRL). VDRL test was carried out using antigen from Serologist to Govt. of India, and all positive sera were confirmed by Treponema Pallidum Haemagglutination Assay. (TPHA, Plasmatec Laboratory Products Ltd.). Presence of IgM antibodies to HSV (1+2) was determined by Enzyme Linked Immunosorbent Assay (ELISA, DIALAB). For diagnosis of BV, Gram stained smear were examined and graded as per standardized, quantitative, and morphological classification developed by Nugent.[4] For diagnosis of trichomoniasis saline wet mount were examined and for candidiasis Gram stained smear were examined. The presence of pseudohyphae and budding yeast cells was considered diagnostic of candidal infection. One endocervical swab was collected according to the instructions provided in the specimen collection and transport kit (Amplicor STD swab collection and transport set) for detection of CT by real‑time PCR (COBAS® TaqMan® CT Test, v2.0) and another for Ng by direct microscopy and culture. Difference of occurrence of STIs/RTIs among HIV positive asymptomatic versus HIV negative asymptomatic women were compared using chi square test and accepted statistically significant when P value is
Indian Journal of Medical Microbiology, (2015) 33(3): 410-412
Brief Communication
Asymptomatic reproductive tract infections/sexually transmitted infections among HIV positive women S Bhattar, *P Bhalla, D Rawat, R Tripathi, R Kaur, K Sardana
Abstract This study aims to highlight the importance of screening all HIV positive women for various reproductive tract infections/sexually transmitted infections (RTIs/STIs) irrespective of symptoms and to determine its occurrence in asymptomatic HIV positive women. Relevant specimens were collected for diagnosis of various RTIs/STIs. STIs were diagnosed in nearly one‑third of the HIV positive asymptomatic patients which is quite high. The national strategy for STIs/RTIs control misses out large number of asymptomatic RTIs/STIs in HIV positive women which is responsible for silently transmitting these infections in the community. So this strategy should be modified to include screening of all HIV positives women irrespective of symptoms of STIs/RTIs. Key words: Asymptomatic, Human immunodeficiency virus (HIV), Reproductive tract infections (RTIs), screening, sexually transmitted infections (STIs)
Introduction Sexually transmitted infections (STIs) are important cofactors that enhance Human immunodeficiency virus (HIV) transmission.[1] HIV‑infected individuals with STI are at greater risk of transmitting HIV than those individuals without STIs.[2] There is also evidence that improved STI control reduces HIV transmission.[1] Under Syndromic case management of reproductive tract infections/sexually transmitted infections (RTIs/STIs), treatment is given only to the symptomatic individuals as it is based on categorization of patients into syndromes on the basis of presenting signs and symptoms.[3] This implies that this strategy misses out patients who are asymptomatic and as a result do not come to the STI clinic. Asymptomatic STIs may function as a hidden reservoir contributing to the ongoing epidemic of symptomatic STIs including HIV. The primary objective of this study was to highlight the importance *Corresponding author (email: ) Department of Microbiology (SB, PB, DR, RK), Department of Obstetrics and Gynaecology (RT), Department of Dermatology and Sexually Transmitted Diseases (KS), Maulana Azad Medical College, Delhi University, New Delhi, India Received: 28-05-2014 Accepted: 13-02-2015 Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.158568
of screening all HIV positive women for various RTIs/STIs irrespective of symptoms and to determine the occurrence of RTIs/STIs in asymptomatic HIV positive women. Materials and Methods This was a cross sectional study conducted prospectively between March 2010 to April 2011 at Integrated Counseling and Testing Centre (ICTC), Department of Microbiology in conjunction with Department of Obstetrics and Gynaecology and Department of Dermatology and STD in a tertiary care centre of northern India. Married women between 18–49 years of age were included in the study while those who were menstruating, pregnant, had received antiretroviral therapy in the past or had received treatment for any RTI in the past 4 weeks were excluded. Cases included 60 HIV positive women, 30 with symptoms (Group A1) and 30 without symptoms of RTI (Group A2). Controls comprised of 60 HIV negative women, 30 with symptoms (Group B1) and 30 without symptoms of RTI (Group B2). All study subjects were recruited in the study following institutional ethical committee clearance. Socio‑demographic data and clinical signs and symptoms were recorded in a proforma after a written informed consent and proper counseling. Each study subject then underwent a general physical, per abdomen, per speculum and per vaginum examination. At recruitment, 5 ml of blood was collected in plain vacutainer for HIV testing, syphilis serology and detection of Herpes simplex virus (HSV) antibody. High vaginal swabs were collected during per speculum examination for diagnosis of bacteria vaginosis (BV), trichomoniasis and candidiasis. Two endocervical swabs were collected for detection of Neisseria gonorrhea (Ng) and Chlamydia trachomatis (CT) infection.
[Downloaded free from http://www.ijmm.org on Saturday, June 13, 2015, IP: 61.16.135.116]
July-September 2015
Bhattar, et al.: Aymptomatic RTIs/STIs among HIV positive women
Diagnosis of HIV infection was done by following the standard protocol at our ICTC. For diagonosis of syphilis serum sample were screened for cardiolipin antibodies by Veneral Disease Research Laboratory test (VDRL). VDRL test was carried out using antigen from Serologist to Govt. of India, and all positive sera were confirmed by Treponema Pallidum Haemagglutination Assay. (TPHA, Plasmatec Laboratory Products Ltd.). Presence of IgM antibodies to HSV (1+2) was determined by Enzyme Linked Immunosorbent Assay (ELISA, DIALAB). For diagnosis of BV, Gram stained smear were examined and graded as per standardized, quantitative, and morphological classification developed by Nugent.[4] For diagnosis of trichomoniasis saline wet mount were examined and for candidiasis Gram stained smear were examined. The presence of pseudohyphae and budding yeast cells was considered diagnostic of candidal infection. One endocervical swab was collected according to the instructions provided in the specimen collection and transport kit (Amplicor STD swab collection and transport set) for detection of CT by real‑time PCR (COBAS® TaqMan® CT Test, v2.0) and another for Ng by direct microscopy and culture. Difference of occurrence of STIs/RTIs among HIV positive asymptomatic versus HIV negative asymptomatic women were compared using chi square test and accepted statistically significant when P value is
