Screenings for Chlamydia trachomatis Antigen among HIV and non-HIV Patients with Symptoms of Urogenital Tract Diseases at The Federal Medical Centre Gombe, Nigeria.
S Charanchi, F Tahir
antigen screening and urogenital swabs, chlamydia trachomatis
S Charanchi, F Tahir. Screenings for Chlamydia trachomatis Antigen among HIV and non-HIV Patients with Symptoms of Urogenital Tract Diseases at The Federal Medical Centre Gombe, Nigeria.. The Internet Journal of Infectious Diseases. 2012 Volume 10 Number 1.
Clinical signs due to Chlamydia, may include: low grade fever, exudates from the cervix and enlargement of local lymph nodes. However, these are not specific to Chlamydia as such where possible, laboratory tests should be performed to determine if evidence
As it has been reported that STIs always facilitate HIV transmission through direct biological mechanisms, early diagnosis and treatment of STIs should therefore be part of a high quality and comprehensive HIV prevention strategy (10).
Although, the diagnosis of Chlamydia infections evolved rapidly with Nucleic acid amplification tests, such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement assay (SDA) now as the mainstays (11), however, screening tests (with high specificity), can presumptively identify Chlamydia infection in asymptomatic patients including pregnant women, (12). Screening for Chlamydia antigens may be performed on swab specimens collected from the cervix (women), urethra (men), or on voided urine, especially in settings where nucleic acid amplification tests or cultural technique is impractical (12).
Because of the improved test accuracy, ease and convenience in specimen management, and hope for screening large number of sexually active men and women, the rapid immunochromatographic screening tests have largely replaced culture (the historic gold standard for Chlamydia diagnosis), and the most expensive nucleic acid amplification as tests in the developing countries (13).
There is also good evidence that screening for Chlamydia infection in women who are at increased risk can reduce the incidence of PID due to Chlamydia as this will prevent mother to child transmission, identify infected among high risk group and improved pregnancy and birth outcomes for women who are treated for Chlamydia infection after screening (14).
This study was therefore set up to identify the possible prevalence of
Materials And Methods
The study was conducted in Federal Medical Centre Gombe, a tertiary hospital within Gombe, the capital city of Gombe State, Nigeria.
This work has received ethical clearance from the Research and Ethical Committee of the Federal Medical Centre Gombe.
A total of 300 Urogenital swabs including 93 urethral swabs (URS) and 207 endocervical swabs (ECS) were aseptically collected from HIV and non HIV-patients attending Federal Medical Centre Gombe with clinical presentation related to urogenital tract diseases.
Screening of Antigen
The screening of the patients for
Data collected and results obtained were presented and statistically analyzed using Chi Square Contingency table.
Table 1 explicit the prevalence of Chlamydia antigen among 300 samples with a total positivity rate of 11(3.7%). Out of the 93 URS samples tested, 3 (3.2%) were positive, while out of 207 ECS tested, 8 (3.9%) were positive. It was observed that in both male (URS) and female (ECS) samples, the highest frequency of Chlamydia antigen was in the age range 21-30years with 4.8% and 4.7% respectively. Chlamydia antigen was not detected in the age group 41-50 and those ≥ 51years in both sexes.
Table2 shows the prevalence of Chlamydia antigen across age and sex of HIV-negative patients presented with symptoms of urogenital tract diseases. Out of 267 non-HIV patients tested, 7 (2.6%) were positive. In the males, highest frequency of Chlamydia antigen was at the age group 21-30 years with 5.6%, while in the females, the highest frequency was at the age group 31-40 with 2.8%.
Table3 however, indicates the occurrence of the Chlamydia antigen across age and sex of HIV-patients tested in this study. Only 33 HIV-patients with symptomatic urogenital tract infections were tested and among them, 4 (12.1%) were reactive to Chlamydia antigen. The highest frequency of the infection was recorded at the age range 31 to 40 years, as 18.2%.
This study indicates a general positivity rate of 3.7% Chlamydia antigen among patients involved. The incidence was very low compared to 27% reported by Anttila (8) among patients screened for cervical carcinoma in the USA, using a technique higher in sensitivity and specificity than one employed in this study.
The highest frequency of 4.8 % and 4.7% observed in males and female at age group 21-30 years is supported by reports from previous works that indicates highest frequency of
High prevalence (4.3%) of Chlamydia antigen was observed in the male age group 31-40. According to Witkin and Bowie (16&17), in a separate works done among asymptomatic males suggested that high prevalence of sexually transmitted infections among adult males in developing countries may not be unconnected to economic stability, ego to have sex and sexual assault by the adult male.
In the non-HIV patients, there was no positive result recorded at age group 41-50 and those ≥51. This may likely be due to fear of HIV and STI or due to high religious morale, lack of sexual ego, poverty or any other factor that may discourage sexual relationship at old age, as suggested in related findings from works done in Potiskum and Ibadan (18&19).
Out of the 33 HIV-seropositive patients with symptoms of urogenital tract infections in this study, high prevalence of 12.1% were screened positive for
Similarly, in this study, it was observed that
Also in the HIV-patients, there was no positive result recorded at the 41-50 and ≥51 years, possible reason as observed by Dale, (23) was that production of squamous epithelial cells (the actual reservoirs for
Looking at the overall result of 3.7% positivity rate, it could be concluded that
It was equally noted that sexually active age may have an impact on the incidence of
Although, there was no significant difference in infections between the two sexes (P< 0.05), a higher prevalence (3.9%), was noticed from the ECS. This confirms that females are more vulnerable to sexually transmitted infections compared to the males.
Finally, a relationship between HIV and
On the ground of the above conclusions, we will like to recommend that, clinicians in tertiary institutions and Federal Medical Centre Gombe in particular should include request for rapid screening of