Etiologies of genital inflammation and ulceration in symptomatic Rwandan men and women responding to radio promotions of free screening and treatment services

The research aimed to assess factors associated with the diagnosis of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in men and women, as well as Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA) in women. The study also explored the relationship between genital ulcers and rapid plasma reagin (RPR) results by HIV status, gender, and circumcision status in men. The study was conducted in Kigali, Rwanda, between January 2016 and August 2019. A total of 1,583 individuals, including 974 men and 569 women, participated in the study. The participants were recruited through radio announcements and pharmacists, and were asked to refer their sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected, and genital exams were performed by trained research nurses and physicians. The study found that 20% of men and 17% of women were positive for CT, while 74% of men and 27% of women were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, suspected exposure within 17 days, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, suspected exposure within 17 days, and not reporting a genital ulcer. Factors associated with CT in women included younger age and symptoms lasting less than or equal to 10 days. Factors associated with NG in women included younger age, lower education, lack of full-time employment, sometimes using condoms, using hormonal contraception, not having a genital ulcer or itching, and symptoms lasting less than or equal to 10 days. The study also found that genital ulcers and positive RPR were associated with being HIV+ and lack of circumcision among men. HIV+ women were more likely to be RPR+. In HIV+ men and women, ulcers were more likely to be herpetic rather than syphilitic compared with their HIV- counterparts. The study's findings suggest that syndromic management guidelines in Rwanda can be improved by considering the prevalence of confirmed infections from this study of symptomatic men and women. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy. The study's results contribute to the epidemiologic data needed to inform improved diagnostic and treatment algorithms in Rwanda. The study was funded by the National Institutes of Health (NIH), the NIH-funded Emory Center for AIDS Research, and the International AIDS Vaccine Initiative (IAVI). The study was conducted in collaboration with the Center for Family Health Research (CFHR) in Kigali, Rwanda, and was approved by the Rwandan National Ethics Committee and the Emory Institutional Review Board. The study's findings have implications for the diagnosis and treatment of genital inflammation and ulceration in Rwanda and other resource-limited settings.