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Abstract：
BACKGROUND: Syndromic management is widely used to treat symptomatic sexually transmitted infections in settings without aetiologic diagnostics. However, underlying aetiologies and consequent treatment suitability are uncertain without regular assessment. This systematic review estimated the distribution, trends, and determinants of aetiologies for vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa (SSA).
RESULTS: We searched Embase, MEDLINE, Global Health, Web of Science, and grey literature from inception until December 20, 2023, for observational studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance, used generalised linear mixed-effects meta-regressions to generate estimates, and critically appraised studies using an adapted Joanna Briggs Institute checklist. Of 4,418 identified records, 206 reports were included from 190 studies in 32 countries conducted between 1969 and 2022. In 2015, estimated primary aetiologies for vaginal discharge were candidiasis (69.4% [95% confidence interval (CI): 44.3% to 86.6%], n = 50), bacterial vaginosis (50.0% [95% CI: 32.3% to 67.8%], n = 39), chlamydia (16.2% [95% CI: 8.6% to 28.5%], n = 50), and trichomoniasis (12.9% [95% CI: 7.7% to 20.7%], n = 80); for urethral discharge were gonorrhoea (77.1% [95% CI: 68.1% to 84.1%], n = 68) and chlamydia (21.9% [95% CI: 15.4% to 30.3%], n = 48); and for genital ulcer were herpes simplex virus type 2 (HSV-2) (48.3% [95% CI: 32.9% to 64.1%], n = 47) and syphilis (9.3% [95% CI: 6.4% to 13.4%], n = 117). Temporal variation was substantial, particularly for genital ulcer where HSV-2 replaced chancroid as the primary cause. Aetiologic distributions for each symptom were largely the same across regions and population strata, despite HIV status and age being significantly associated with several infection diagnoses. Limitations of the review include the absence of studies in 16 of 48 SSA countries, substantial heterogeneity in study observations, and impeded assessment of this variability due to incomplete or inconsistent reporting across studies.
CONCLUSIONS: In our study, syndrome aetiologies in SSA aligned with World Health Organization guidelines without strong evidence of geographic or demographic variation, supporting broad guideline applicability. Temporal changes underscore the importance of regular aetiologic re-assessment for effective syndromic management.
UNASSIGNED: CRD42022348045.
RESULTS: We searched Embase, MEDLINE, Global Health, Web of Science, and grey literature from inception until December 20, 2023, for observational studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance, used generalised linear mixed-effects meta-regressions to generate estimates, and critically appraised studies using an adapted Joanna Briggs Institute checklist. Of 4,418 identified records, 206 reports were included from 190 studies in 32 countries conducted between 1969 and 2022. In 2015, estimated primary aetiologies for vaginal discharge were candidiasis (69.4% [95% confidence interval (CI): 44.3% to 86.6%], n = 50), bacterial vaginosis (50.0% [95% CI: 32.3% to 67.8%], n = 39), chlamydia (16.2% [95% CI: 8.6% to 28.5%], n = 50), and trichomoniasis (12.9% [95% CI: 7.7% to 20.7%], n = 80); for urethral discharge were gonorrhoea (77.1% [95% CI: 68.1% to 84.1%], n = 68) and chlamydia (21.9% [95% CI: 15.4% to 30.3%], n = 48); and for genital ulcer were herpes simplex virus type 2 (HSV-2) (48.3% [95% CI: 32.9% to 64.1%], n = 47) and syphilis (9.3% [95% CI: 6.4% to 13.4%], n = 117). Temporal variation was substantial, particularly for genital ulcer where HSV-2 replaced chancroid as the primary cause. Aetiologic distributions for each symptom were largely the same across regions and population strata, despite HIV status and age being significantly associated with several infection diagnoses. Limitations of the review include the absence of studies in 16 of 48 SSA countries, substantial heterogeneity in study observations, and impeded assessment of this variability due to incomplete or inconsistent reporting across studies.
CONCLUSIONS: In our study, syndrome aetiologies in SSA aligned with World Health Organization guidelines without strong evidence of geographic or demographic variation, supporting broad guideline applicability. Temporal changes underscore the importance of regular aetiologic re-assessment for effective syndromic management.
UNASSIGNED: CRD42022348045.
摘要：
背景：在没有病因诊断的情况下，综合征管理被广泛用于治疗有症状的性传播感染。然而,如果没有定期评估，潜在的病因和随后的治疗适用性是不确定的。这项系统的审查估计了分布，趋势,以及阴道分泌物病因的决定因素，尿道分泌物,撒哈拉以南非洲（SSA）的生殖器溃疡。
结果：我们搜索了Embase，MEDLINE,全球卫生,WebofScience,以及从开始到2023年12月20日的灰色文献，用于观察性研究，报告SSA有症状人群的病因学诊断。我们调整了诊断测试性能的观察结果，使用广义线性混合效应元回归来生成估计，并使用经过调整的乔安娜·布里格斯研究所清单对研究进行了严格评估。在4418条识别记录中，纳入了1969年至2022年在32个国家进行的190项研究的206份报告。2015年，估计阴道分泌物的主要病因是念珠菌病（69.4％[95％置信区间（CI）：44.3％至86.6％]，n=50),细菌性阴道病（50.0%[95%CI：32.3%至67.8%]，n=39),衣原体（16.2%[95%CI：8.6%至28.5%]，n=50),和滴虫病（12.9%[95%CI：7.7%至20.7%]，n=80）；尿道分泌物为淋病（77.1％[95％CI：68.1％至84.1％]，n=68）和衣原体（21.9%[95%CI：15.4%至30.3%]，n=48）；生殖器溃疡为单纯疱疹病毒2型（HSV-2）（48.3%[95%CI：32.9%至64.1%]，n=47）和梅毒（9.3%[95%CI：6.4%至13.4%]，n=117）。时间变化很大，特别是对于生殖器溃疡，HSV-2取代了软下体作为主要原因。每种症状的病因学分布在不同地区和人口阶层中基本相同，尽管HIV感染状态和年龄与一些感染诊断显着相关。审查的局限性包括48个SSA国家中的16个国家缺乏研究，研究观察中的实质性异质性，并且由于研究报告不完整或不一致，因此阻碍了对这种变异性的评估。
结论：在我们的研究中，SSA的综合征病因与世界卫生组织指南一致，没有明确的地理或人口统计学差异的证据。支持广泛的准则适用性。时间变化强调了定期病因学重新评估对于有效的综合征管理的重要性。
■CRD42022348045。
结果：我们搜索了Embase，MEDLINE,全球卫生,WebofScience,以及从开始到2023年12月20日的灰色文献，用于观察性研究，报告SSA有症状人群的病因学诊断。我们调整了诊断测试性能的观察结果，使用广义线性混合效应元回归来生成估计，并使用经过调整的乔安娜·布里格斯研究所清单对研究进行了严格评估。在4418条识别记录中，纳入了1969年至2022年在32个国家进行的190项研究的206份报告。2015年，估计阴道分泌物的主要病因是念珠菌病（69.4％[95％置信区间（CI）：44.3％至86.6％]，n=50),细菌性阴道病（50.0%[95%CI：32.3%至67.8%]，n=39),衣原体（16.2%[95%CI：8.6%至28.5%]，n=50),和滴虫病（12.9%[95%CI：7.7%至20.7%]，n=80）；尿道分泌物为淋病（77.1％[95％CI：68.1％至84.1％]，n=68）和衣原体（21.9%[95%CI：15.4%至30.3%]，n=48）；生殖器溃疡为单纯疱疹病毒2型（HSV-2）（48.3%[95%CI：32.9%至64.1%]，n=47）和梅毒（9.3%[95%CI：6.4%至13.4%]，n=117）。时间变化很大，特别是对于生殖器溃疡，HSV-2取代了软下体作为主要原因。每种症状的病因学分布在不同地区和人口阶层中基本相同，尽管HIV感染状态和年龄与一些感染诊断显着相关。审查的局限性包括48个SSA国家中的16个国家缺乏研究，研究观察中的实质性异质性，并且由于研究报告不完整或不一致，因此阻碍了对这种变异性的评估。
结论：在我们的研究中，SSA的综合征病因与世界卫生组织指南一致，没有明确的地理或人口统计学差异的证据。支持广泛的准则适用性。时间变化强调了定期病因学重新评估对于有效的综合征管理的重要性。
■CRD42022348045。
