Influence of HIV-1 Coinfection on Effective Management of Abnormal Vaginal Discharge

In Brief Background Reports on microbiologic cure rates following syndromic management (SM) of women with nonulcerative sexually transmitted infections (STIs) are limited. Goal The goal of the study was to determine the effectiveness of the drugs used in SM of nonulcerative STIs and bacterial vaginosis in women and to compare the response among those with and without HIV-1 coinfection. Study Design This was a cohort study of women with nonulcerative STIs who were treated according to local SM protocols. Results Of 692 women recruited, 415 (80%) returned 8 to 10 days later, and 290 (70%) consented to a second examination, in which specimens were obtained. Clinical cure was reported by 67%, and microbiologic cure ranged from 80% to 89% for the three discharge-causing STIs and was independent of HIV-1 status. Only 38% of those with bacterial vaginosis were cured, and HIV-1-infected women were less likely to be cured (28% versus 52%;P < 0.001). Conclusions Clinical and microbiologic response to SM of the nonulcerative STIs was not affected by HIV-1 coinfection, but cure rates for bacterial vaginosis were reduced. Analysis of the impact of HIV-1 on response to syndromic drug therapy for nonulcerative sexually transmitted infections (STIs) and bacterial vaginosis in women showed the classic STIs to be independent of HIV-1 coinfection, while response of bacterial vaginosis to therapy was reduced.