{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:59:16Z","timestamp":1780066756503,"version":"3.54.0"},"reference-count":68,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000866","name":"IAVI","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000866","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["NIAID R01 AI51231"],"award-info":[{"award-number":["NIAID R01 AI51231"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"name":"NIH AIDS International Training and Research Program Fogarty International Center","award":["D43 TW001042"],"award-info":[{"award-number":["D43 TW001042"]}]},{"name":"NIH-funded Emory Center for AIDS Research","award":["P30 AI050409"],"award-info":[{"award-number":["P30 AI050409"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>The longstanding inadequacies of syndromic management for genital ulceration and inflammation are well-described. The Rwanda National Guidelines for sexually transmitted infection (STI) syndromic management are not yet informed by the local prevalence and correlates of STI etiologies, a component World Health Organization guidelines stress as critical to optimize locally relevant algorithms.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>Radio announcements and pharmacists recruited symptomatic patients to seek free STI services in Kigali. Clients who sought services were asked to refer sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected. Genital exams were performed by trained research nurses and physicians. We conducted phlebotomy for rapid HIV and rapid plasma reagin (RPR) serologies and vaginal pool swab for microscopy of wet preparation to diagnose Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA). GeneXpert testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were conducted. Here we assess factors associated with diagnosis of NG and CT in men and women. We also explore factors associated with TV, BV and VCA in women. Finally, we describe genital ulcer and RPR results by HIV status, gender, and circumcision in men.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Among 974 men (with 1013 visits), 20% were positive for CT and 74% were positive for NG. Among 569 women (with 579 visits), 17% were positive for CT and 27% were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, responding to radio advertisements, &lt;17 days since suspected exposure, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, &lt;17 days since suspected exposure, not reporting a genital ulcer, and having urethral discharge on physical exam. Factors associated with CT in women included younger age and &lt; = 10 days with symptoms. Factors associated with NG in women included younger age, lower education and lack of full-time employment, sometimes using condoms<jats:italic>vs<\/jats:italic>. never, using hormonal<jats:italic>vs<\/jats:italic>. non-hormonal contraception, not having genital ulcer or itching, having symptoms &lt; = 10 days, HIV+ status, having BV, endocervical discharge noted on speculum exam, and negative vaginal wet mount for VCA. In multivariate analyses, only reporting &gt;1 partner was associated with BV; being single and RPR+ was associated with TV; and having &lt; = 1 partner in the last month, being pregnant, genital itching, discharge, and being HIV and RPR negative were associated with VCA. 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.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>Syndromic management guidelines in Rwanda can be improved with consideration of the prevalence of confirmed infections from this study of symptomatic men and women representative of those who would seek care at government health centers. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0250044","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T21:08:33Z","timestamp":1618952913000},"page":"e0250044","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Etiologies of genital inflammation and ulceration in symptomatic Rwandan men and women responding to radio promotions of free screening and treatment services"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-2004","authenticated-orcid":true,"given":"Kristin M.","family":"Wall","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Nyombayire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosine","family":"Ingabire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Bizimana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannine","family":"Mukamuyango","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Mazzei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt A.","family":"Price","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8917-2305","authenticated-orcid":true,"given":"Marie Aimee","family":"Unyuzimana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Tichacek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Allen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Karita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"key":"pone.0250044.ref001","volume-title":"Sexually transmitted infections (STIs)","author":"World_Health_Organization","year":"2019"},{"key":"pone.0250044.ref002","volume-title":"Sexually Transmiited Infections","author":"World_Health_Organization","year":"2019"},{"key":"pone.0250044.ref003","unstructured":"World_Health_Organization. Global health sector strategy on Sexually Transmitted Infections, 2016\u20132021: WHO; 2016 [updated July 2016]. Available from: http:\/\/www.who.int\/reproductivehealth\/publications\/rtis\/ghss-stis\/en\/."},{"issue":"6193","key":"pone.0250044.ref004","doi-asserted-by":"crossref","first-page":"1254031","DOI":"10.1126\/science.1254031","article-title":"HIV transmission. Selection bias at the heterosexual HIV-1 transmission bottleneck","volume":"345","author":"JM Carlson","year":"2014","journal-title":"Science (New York, NY)."},{"key":"pone.0250044.ref005","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/1756-0500-4-64","article-title":"Risk Factors for HSV-2 Infection among Sexual Partners of HSV-2\/HIV-1 Co-Infected Persons.","volume":"4","author":"A Mujugira","year":"2011","journal-title":"BMC Res Notes."},{"issue":"1","key":"pone.0250044.ref006","doi-asserted-by":"crossref","first-page":"e1000274","DOI":"10.1371\/journal.ppat.1000274","article-title":"Inflammatory genital infections mitigate a severe genetic bottleneck in heterosexual transmission of subtype A and C HIV-1.","volume":"5","author":"RE Haaland","year":"2009","journal-title":"PLoS pathogens."},{"issue":"Suppl 4","key":"pone.0250044.ref007","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1097\/00002030-200108004-00003","article-title":"Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection","volume":"15","author":"B Auvert","year":"2001","journal-title":"AIDS"},{"issue":"2","key":"pone.0250044.ref008","first-page":"4","article-title":"AIDS: the impact of other sexually transmitted diseases","volume":"9","author":"P. Piot","year":"1988","journal-title":"Netw Res Triangle Park N C"},{"key":"pone.0250044.ref009","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1744-8603-10-46","article-title":"Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa.","volume":"10","author":"A Dhana","year":"2014","journal-title":"Global Health"},{"issue":"1","key":"pone.0250044.ref010","doi-asserted-by":"crossref","first-page":"e54953","DOI":"10.1371\/journal.pone.0054953","article-title":"Prevalence of HIV and other sexually transmitted infections among female sex workers in Kisumu, Western Kenya, 1997 and 2008.","volume":"8","author":"HM Vandenhoudt","year":"2013","journal-title":"PLoS One."},{"issue":"3","key":"pone.0250044.ref011","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1136\/sti.2008.034678","article-title":"Using mathematical modelling to estimate the impact of periodic presumptive treatment on the transmission of sexually transmitted infections and HIV among female sex workers.","volume":"86","author":"P Vickerman","year":"2010","journal-title":"Sex Transm Infect"},{"issue":"3","key":"pone.0250044.ref012","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1136\/sti.77.3.190","article-title":"Prevalence and risk factors of cervicovaginal HIV shedding among HIV-1 and HIV-2 infected women in Dakar, Senegal.","volume":"77","author":"K Seck","year":"2001","journal-title":"Sex Transm Infect"},{"issue":"5","key":"pone.0250044.ref013","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1056\/NEJMoa0904849","article-title":"Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2","volume":"362","author":"C Celum","year":"2010","journal-title":"The New England journal of medicine"},{"issue":"1","key":"pone.0250044.ref014","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1186\/s13104-016-2319-5","article-title":"Prevalence of Herpes Simplex Virus 2 (HSV-2) infection and associated risk factors in a cohort of HIV negative women in Durban, South Africa.","volume":"9","author":"B Daniels","year":"2016","journal-title":"BMC Res Notes."},{"issue":"5","key":"pone.0250044.ref015","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1093\/ije\/dyx045","article-title":"Risk of heterosexual HIV transmission attributable to sexually transmitted infections and non-specific genital inflammation in Zambian discordant couples, 1994\u20132012.","volume":"46","author":"KM Wall","year":"2017","journal-title":"Int J Epidemiol."},{"issue":"2","key":"pone.0250044.ref016","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/QAI.0000000000001494","article-title":"HIV Incidence and Predictors of HIV Acquisition From an Outside Partner in Serodiscordant Couples in Lusaka, Zambia.","volume":"76","author":"DL Joseph Davey","year":"2017","journal-title":"J Acquir Immune Defic Syndr."},{"issue":"46","key":"pone.0250044.ref017","doi-asserted-by":"crossref","first-page":"E1156","DOI":"10.1073\/pnas.1103764108","article-title":"Role of donor genital tract HIV-1 diversity in the transmission bottleneck","volume":"108","author":"DI Boeras","year":"2011","journal-title":"Proceedings of the National Academy of Sciences of the United States of America"},{"issue":"2","key":"pone.0250044.ref018","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/S1473-3099(19)30470-0","article-title":"Global and regional estimates of the contribution of herpes simplex virus type 2 infection to HIV incidence: a population attributable fraction analysis using published epidemiological data","volume":"20","author":"KJ Looker","year":"2020","journal-title":"Lancet Infect Dis."},{"issue":"9","key":"pone.0250044.ref019","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1097\/OLQ.0000000000001006","article-title":"Serological Markers for Syphilis Among Persons Presenting With Syndromes Associated With Sexually Transmitted Infections: Results From the Zimbabwe STI Etiology Study.","volume":"46","author":"CA Rietmeijer","year":"2019","journal-title":"Sex Transm Dis."},{"issue":"1","key":"pone.0250044.ref020","first-page":"1","article-title":"The cofactor effect of genital ulcers on the per-exposure risk of HIV transmission in sub-Saharan Africa","volume":"98","author":"RJ Hayes","year":"1995","journal-title":"J Trop Med Hyg"},{"issue":"12","key":"pone.0250044.ref021","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1097\/OLQ.0000000000000051","article-title":"Etiology of genital ulcer disease and association with HIV infection in Malawi.","volume":"40","author":"S Phiri","year":"2013","journal-title":"Sex Transm Dis"},{"issue":"12","key":"pone.0250044.ref022","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1097\/OLQ.0000000000000204","article-title":"Etiology and antimicrobial susceptibility of pathogens responsible for urethral discharge among men in Harare, Zimbabwe.","volume":"41","author":"S Takuva","year":"2014","journal-title":"Sex Transm Dis"},{"issue":"3","key":"pone.0250044.ref023","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4314\/gmj.v50i3.5","article-title":"Bacterial etiology of sexually transmitted infections at a STI clinic in Ghana; use of multiplex real time PCR.","volume":"50","author":"AA Sylverken","year":"2016","journal-title":"Ghana Med J"},{"issue":"6","key":"pone.0250044.ref024","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1097\/OLQ.0000000000000771","article-title":"The Etiology of Vaginal Discharge Syndrome in Zimbabwe: Results from the Zimbabwe STI Etiology Study.","volume":"45","author":"ZM Chirenje","year":"2018","journal-title":"Sex Transm Dis."},{"issue":"5","key":"pone.0250044.ref025","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/QAD.0000000000001741","article-title":"Bacterial vaginosis modifies the association between hormonal contraception and HIV acquisition","volume":"32","author":"LB Haddad","year":"2018","journal-title":"AIDS"},{"issue":"6","key":"pone.0250044.ref026","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1177\/0956462417740487","article-title":"Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV","volume":"29","author":"SL Barnabas","year":"2018","journal-title":"Int J STD AIDS"},{"issue":"1","key":"pone.0250044.ref027","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1186\/s12879-018-3455-4","article-title":"Urogenital pathogens, associated with Trichomonas vaginalis, among pregnant women in Kilifi, Kenya: a nested case-control study.","volume":"18","author":"SC Masha","year":"2018","journal-title":"BMC Infect Dis"},{"issue":"4","key":"pone.0250044.ref028","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1136\/sextrans-2015-052371","article-title":"Prevalence of reproductive tract infections and the predictive value of girls\u2019 symptom-based reporting: findings from a cross-sectional survey in rural western Kenya.","volume":"92","author":"E Kerubo","year":"2016","journal-title":"Sex Transm Infect"},{"issue":"6","key":"pone.0250044.ref029","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1136\/sextrans-2013-051049","article-title":"Trends and associations of Trichomonas vaginalis infection in men and women with genital discharge syndromes in Johannesburg, South Africa.","volume":"89","author":"DA Lewis","year":"2013","journal-title":"Sex Transm Infect"},{"key":"pone.0250044.ref030","doi-asserted-by":"crossref","first-page":"3946862","DOI":"10.1155\/2018\/3946862","article-title":"Acceptability and Feasibility of Integrating Point-of-Care Diagnostic Testing of Sexually Transmitted Infections into a South African Antenatal Care Program for HIV-Infected Pregnant Women.","volume":"2018","author":"E Morikawa","year":"2018","journal-title":"Infect Dis Obstet Gynecol."},{"issue":"4","key":"pone.0250044.ref031","doi-asserted-by":"crossref","first-page":"e0196209","DOI":"10.1371\/journal.pone.0196209","article-title":"Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries.","volume":"13","author":"NJ Garrett","year":"2018","journal-title":"PLoS One."},{"issue":"7","key":"pone.0250044.ref032","doi-asserted-by":"crossref","first-page":"e101221","DOI":"10.1371\/journal.pone.0101221","article-title":"Epidemiology of curable sexually transmitted infections among women at increased risk for HIV in northwestern Tanzania: inadequacy of syndromic management.","volume":"9","author":"SC Francis","year":"2014","journal-title":"PLoS One."},{"issue":"10","key":"pone.0250044.ref033","doi-asserted-by":"crossref","first-page":"720","DOI":"10.3855\/jidc.2752","article-title":"Assessing therapeutic management of vaginal and urethral symptoms in an anonymous HIV testing centre in Luanda, Angola.","volume":"7","author":"H Guimaraes","year":"2013","journal-title":"J Infect Dev Ctries"},{"issue":"8","key":"pone.0250044.ref034","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1258\/ijsa.2010.010005","article-title":"Diagnosis of sexually transmitted infections and bacterial vaginosis among HIV-1-infected pregnant women in Nairobi.","volume":"21","author":"G Marx","year":"2010","journal-title":"Int J STD AIDS"},{"issue":"4","key":"pone.0250044.ref035","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1136\/sti.2007.028464","article-title":"The detection of urethritis pathogens among patients with the male urethritis syndrome, genital ulcer syndrome and HIV voluntary counselling and testing clients: should South Africa\u2019s syndromic management approach be revised?","volume":"84","author":"V Black","year":"2008","journal-title":"Sex Transm Infect"},{"issue":"4","key":"pone.0250044.ref036","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/j.1365-2648.2007.04405.x","article-title":"Opportunities for treating sexually transmitted infections and reducing HIV risk in rural South Africa.","volume":"60","author":"JA Frohlich","year":"2007","journal-title":"J Adv Nurs"},{"issue":"4","key":"pone.0250044.ref037","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1136\/sti.2005.014845","article-title":"Lack of effectiveness of syndromic management in targeting vaginal infections in pregnancy in Entebbe, Uganda.","volume":"82","author":"CJ Tann","year":"2006","journal-title":"Sex Transm Infect"},{"issue":"6","key":"pone.0250044.ref038","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1177\/0956462418817050","article-title":"Female sex workers in Kigali, Rwanda: a key population at risk of HIV, sexually transmitted infections, and unplanned pregnancy","volume":"30","author":"R Ingabire","year":"2019","journal-title":"Int J STD AIDS"},{"key":"pone.0250044.ref039","unstructured":"RWANDA POPULATION-BASED HIV IMPACT ASSESSMENT RPHIA 2018\u20132019 2019 [cited 2020 Nov 20]. Available from: https:\/\/phia.icap.columbia.edu\/wp-content\/uploads\/2019\/10\/RPHIA-Summary-Sheet_Oct-2019.pdf."},{"key":"pone.0250044.ref040","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1758-2652-13-10","article-title":"Couples\u2019 voluntary counselling and testing and nevirapine use in antenatal clinics in two African capitals: a prospective cohort study","volume":"13","author":"M Conkling","year":"2010","journal-title":"Journal of the International AIDS Society"},{"issue":"3","key":"pone.0250044.ref041","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1097\/QAI.0000000000001138","article-title":"Implementation and Operational Research: Evolution of Couples\u2019 Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice.","volume":"73","author":"E Karita","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"pone.0250044.ref042","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s12978-019-0739-0","article-title":"Community health worker promotions increase uptake of long-acting reversible contraception in Rwanda.","volume":"16","author":"A Mazzei","year":"2019","journal-title":"Reprod Health"},{"issue":"38","key":"pone.0250044.ref043","first-page":"38","article-title":"Evaluation of a multi-level intervention to improve postpartum intrauterine device services in Rwanda.","volume":"2","author":"R Ingabire","year":"2018","journal-title":"Gates Open Res"},{"issue":"1","key":"pone.0250044.ref044","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/OLQ.0000000000000696","article-title":"The Etiology of Male Urethral Discharge in Zimbabwe: Results from the Zimbabwe STI Etiology Study.","volume":"45","author":"CA Rietmeijer","year":"2018","journal-title":"Sex Transm Dis."},{"key":"pone.0250044.ref045","unstructured":"Gonorrhea\u2014CDC Fact Sheet (Detailed Version): U.S. Centers for Disease Control; 2020 [cited 2020 6\/29\/2020]. Available from: https:\/\/www.cdc.gov\/std\/gonorrhea\/stdfact-gonorrhea-detailed.htm."},{"issue":"1","key":"pone.0250044.ref046","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1186\/s12879-019-4035-y","article-title":"Risk factors associated with gonorrhea and chlamydia transmission in selected health facilities in Ghana.","volume":"19","author":"H Dela","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"4","key":"pone.0250044.ref047","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1177\/0956462419894453","article-title":"Sociodemographic factors and STIs associated with Chlamydia trachomatis and Neisseria gonorrhoeae infections in Zambian female sex workers and single mothers","volume":"31","author":"S Connolly","year":"2020","journal-title":"Int J STD AIDS"},{"issue":"1","key":"pone.0250044.ref048","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/OLQ.0000000000000694","article-title":"The Etiology of Genital Ulcer Disease and Coinfections With Chlamydia trachomatis and Neisseria gonorrhoeae in Zimbabwe: Results From the Zimbabwe STI Etiology Study.","volume":"45","author":"M Mungati","year":"2018","journal-title":"Sex Transm Dis."},{"issue":"6","key":"pone.0250044.ref049","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1016\/j.juro.2011.02.2702","article-title":"Editorial comment.","volume":"185","author":"AE MacNeily","year":"2011","journal-title":"J Urol"},{"issue":"2","key":"pone.0250044.ref050","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1136\/sti.2005.017442","article-title":"Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis.","volume":"82","author":"HA Weiss","year":"2006","journal-title":"Sex Transm Infect"},{"issue":"11","key":"pone.0250044.ref051","doi-asserted-by":"crossref","first-page":"e1054","DOI":"10.1016\/S2214-109X(17)30386-8","article-title":"Effect of male circumcision on risk of sexually transmitted infections and cervical cancer in women","volume":"5","author":"BJ Morris","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"3","key":"pone.0250044.ref052","doi-asserted-by":"crossref","first-page":"e001389","DOI":"10.1136\/bmjgh-2019-001389","article-title":"Does voluntary medical male circumcision protect against sexually transmitted infections among men and women in real-world scale-up settings? Findings of a household survey in KwaZulu-Natal, South Africa.","volume":"4","author":"S Davis","year":"2019","journal-title":"BMJ Glob Health"},{"issue":"9","key":"pone.0250044.ref053","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1097\/QAD.0b013e328352d116","article-title":"Circumcision status and incident herpes simplex virus type 2 infection, genital ulcer disease, and HIV infection","volume":"26","author":"SD Mehta","year":"2012","journal-title":"AIDS"},{"issue":"4","key":"pone.0250044.ref054","doi-asserted-by":"crossref","first-page":"e0194125","DOI":"10.1371\/journal.pone.0194125","article-title":"Trends in the relative prevalence of genital ulcer disease pathogens and association with HIV infection in Johannesburg, South Africa, 2007\u20132015.","volume":"13","author":"RS Kularatne","year":"2018","journal-title":"PLoS One."},{"issue":"11","key":"pone.0250044.ref055","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1258\/0956462981921242","article-title":"Genital ulcers in a primary health clinic in Rwanda: impact of HIV infection on diagnosis and ulcer healing (1986\u20131992).","volume":"9","author":"J Bogaerts","year":"1998","journal-title":"Int J STD AIDS"},{"issue":"6","key":"pone.0250044.ref056","first-page":"761","article-title":"Simple algorithms for the management of genital ulcers: evaluation in a primary health care centre in Kigali, Rwanda","volume":"73","author":"J Bogaerts","year":"1995","journal-title":"Bull World Health Organ"},{"issue":"7","key":"pone.0250044.ref057","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1128\/AAC.38.7.1647","article-title":"Emergence of Haemophilus ducreyi resistance to trimethoprim-sulfamethoxazole in Rwanda","volume":"38","author":"E Van Dyck","year":"1994","journal-title":"Antimicrob Agents Chemother"},{"issue":"1","key":"pone.0250044.ref058","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/00007435-199401000-00008","article-title":"Enzyme immunoassays (EIAs) for the detection of anti-Haemophilus ducreyi serum IgA, IgG, and IgM antibodies.","volume":"21","author":"EL Roggen","year":"1994","journal-title":"Sex Transm Dis."},{"issue":"3","key":"pone.0250044.ref059","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/00007435-198907000-00001","article-title":"The etiology of genital ulceration in Rwanda.","volume":"16","author":"J Bogaerts","year":"1989","journal-title":"Sex Transm Dis"},{"issue":"5","key":"pone.0250044.ref060","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1086\/514751","article-title":"Genital ulcers: setiology, clinical diagnosis, and associated human immunodeficiency virus infection in Kingston, Jamaica","volume":"28","author":"FM Behets","year":"1999","journal-title":"Clin Infect Dis"},{"key":"pone.0250044.ref061","article-title":"A population-specific optimized GeneXpert pooling algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae to reduce cost of molecular STI screening in resource-limited settings","author":"S Connolly","year":"2020","journal-title":"J Clin Microbiol"},{"issue":"1","key":"pone.0250044.ref062","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.srhc.2010.08.006","article-title":"The effect of syndromic management interventions on the prevalence of sexually transmitted infections in South Africa.","volume":"2","author":"LF Johnson","year":"2011","journal-title":"Sex Reprod Healthc"},{"issue":"2","key":"pone.0250044.ref063","doi-asserted-by":"crossref","first-page":"e026888","DOI":"10.1136\/bmjopen-2018-026888","article-title":"Diagnostic accuracy of the Xpert CT\/NG and OSOM Trichomonas Rapid assays for point-of-care STI testing among young women in South Africa: a cross-sectional study","volume":"9","author":"N Garrett","year":"2019","journal-title":"BMJ Open"},{"issue":"4","key":"pone.0250044.ref064","doi-asserted-by":"crossref","first-page":"e5272","DOI":"10.1371\/journal.pone.0005272","article-title":"Characteristics of HIV-1 discordant couples enrolled in a trial of HSV-2 suppression to reduce HIV-1 transmission: the partners study.","volume":"4","author":"JR Lingappa","year":"2009","journal-title":"PLoS One."},{"key":"pone.0250044.ref065","unstructured":"Cousins S. How Rwanda could be the first country to wipe out cervical cancer: Mosaicscience.com; 2019 [updated 7May2019]. Available from: https:\/\/mosaicscience.com\/story\/rwanda-cervical-cancer-hpv-vaccine-gardasil-cervarix\/."},{"issue":"12","key":"pone.0250044.ref066","doi-asserted-by":"crossref","first-page":"e0006902","DOI":"10.1371\/journal.pntd.0006902","article-title":"Schistosomiasis is associated with incident HIV transmission and death in Zambia.","volume":"12","author":"KM Wall","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pone.0250044.ref067","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1097\/COH.0b013e328351b9e3","article-title":"The effects of schistosomiasis on HIV\/AIDS infection, progression and transmission.","volume":"7","author":"WE Secor","year":"2012","journal-title":"Current opinion in HIV and AIDS."},{"issue":"1","key":"pone.0250044.ref068","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40249-016-0212-z","article-title":"Schistosomiasis and soil-transmitted helminthiasis in Rwanda: an update on their epidemiology and control.","volume":"6","author":"N Rujeni","year":"2017","journal-title":"Infect Dis Poverty."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T21:35:08Z","timestamp":1671917708000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250044"}},"subtitle":[],"editor":[{"given":"Antonella","family":"Marangoni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,20]]},"references-count":68,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0250044","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,20]]}}}