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Serological Markers for Syphilis Among Persons Presenting With Syndromes Associated With Sexually Transmitted Infections

Results From the Zimbabwe STI Etiology Study

Rietmeijer, Cornelis A. MD, PhD, MSPH*,†; Mungati, More MBChB, MPH; Kilmarx, Peter H. MD*,§; Barr, Beth Tippett DrPH§; Gonese, Elizabeth MPH§; Kularatne, Ranmini S. MBChB, MSc¶,∥; Lewis, David A. FRCP (UK), PhD**,††; Klausner, Jeffrey D. MD, MPH‡‡; Rodgers, Luanne BS§§; Handsfield, H. Hunter MD¶¶

doi: 10.1097/OLQ.0000000000001006
Original Studies
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Background Syphilis prevalence in sub-Saharan Africa appears to be stable or declining but is still the highest globally. Ongoing sentinel surveillance in high-risk populations is necessary to inform management and detect changes in syphilis trends. We assessed serological syphilis markers among persons with sexually transmitted infections in Zimbabwe.

Methods We studied a predominantly urban, regionally diverse group of women and men presenting with genital ulcer disease (GUD), women with vaginal discharge and men with urethral discharge at clinics in Zimbabwe. Syphilis tests included rapid plasma reagin and the Treponema pallidum hemagglutination assay.

Results Among 436 evaluable study participants, 36 (8.3%) tested positive for both rapid plasma reagin and Treponema pallidum hemagglutination assay: women with GUD: 19.2%, men with GUD: 12.6%, women with vaginal discharge: 5.7% and men with urethral discharge: 1.5% (P < 0.0001).

Conclusions Syphilis rates in Zimbabwe are high in sentinel populations, especially men and women with GUD.

Syphilis rates in Zimbabwe are high in sentinel populations, especially among men and women with genital ulcer disease.

From the *Rietmeijer Consulting, LLC, Denver, CO

Colorado School of Public Health, University of Colorado Denver, Denver, CO

Elizabeth Glazer Pediatric AIDS Foundation, Lesotho

§Centers for Disease Control and Prevention, Division of Global Health and Tuberculosis, Harare, Zimbabwe

Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa

Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

**Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia

††Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School-Westmead, University of Sydney, Sydney, New South Wales, Australia

‡‡Department of Medicine, Division of Infectious Diseases and Center for World Health, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA

§§Biomedical Research and Training Institute, Harare, Zimbabwe

¶¶University of Washington School of Medicine, Seattle, WA

P.H.K.: current author affiliation: Fogarty International Center, National Institutes of Health, Bethesda, MD.

Acknowledgments: ZiCHIRe Study Team: -Vitalis Kupara, State Registered Nurse (SRN). Mebbina Muswera, State Registered Nurse and State Registered Midwife (SRN, SRM). Sarah Vundhla, State Registered Nurse and State Registered Midwife (SRN, SRM). Shirley Tshimanga, State Registered Nurse and State Registered Midwife (SRN, SRM).

This study could not have been conducted without the gracious support and collaboration of the staff and patients of the following clinics: Harare: Mbare and Budiriro clinics. Bulawayo: Nkulumane and Khami Road Clinics. Beitbridge: Dulibadzimu Clinic. Gutu: Gutu Rural Hospital.

Funding: The Zimbabwe STI Etiology Study was supported by funds from the President's Emergency Plan for AIDS Relief (PEPFAR) through a cooperative agreement between the U.S. Centers for Disease Control and Prevention and the University of Zimbabwe Department of Community Medicine SEAM Project under the terms of Cooperative Agreement Number IU2GGH000315-01.

Conflicts of interest: none declared.

Correspondence: Cornelis A. Rietmeijer, MD, PhD, MSPH, Rietmeijer Consulting, LLC, Denver, CO. E-mail: kees@rietmeijer.us.

Received for publication October 19, 2018, and accepted March 6, 2019.

Online date: April 18, 2019

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