I have only used Sim Spawn Overhaul. I have never had a problem with culling, but perhaps that is because I tend to do my own. I pretty much cull townie Sims who aren't friends after one to three days playing.
I think most of the mods that conflict with Sim Spawn Overhaul are included in the mod. I did notice that civilian Sims were slow to show up at the police station. Not sure if this mod was the cause. One did eventually show up though.
For me not having to see Nancy Landgrabb in every land makes it well worth it.