Patterns of prevalent HPV and STI co-infections and associated factors among HIV-negative young Western Cape, South African women: the EVRI trial.

Menezes LJ, Pokharel U, Sudenga SL, Botha MH, Zeier M, Abrahamsen ME, Glashoff RH, Engelbrecht S, Schim van der Loeff MF, van der Laan LE, Kipping S, Taylor D, Giuliano AR
Sex Transm Infect. 2018 94 (1): 55-61

PMID: 28490581 · PMCID: PMC6561095 · DOI:10.1136/sextrans-2016-053046

OBJECTIVE - To estimate the prevalence and describe the patterns of concurrent human papillomavirus (HPV) and STIs and associated factors among HIV-negative young Western Cape, South African women participating in the Efficacy of HPV Vaccine to Reduce HIV Infection (EVRI) trial.

METHODS - HIV-negative women aged 16-24 years old were enrolled in the EVRI trial (NCT01489527) and randomised to receive the licensed four-valent HPV vaccine or placebo. At study entry, participants were clinically evaluated for five STIs: herpes simplex virus type 2 (HSV-2), chlamydia, gonorrhoea, syphilis and disease-causing HPV genotypes (6/11/16/18/31/33/35/39/45/51/52/56/58/59/68). Demographic and sexual history characteristics were compared among women with STI co-infections, single infection and no infection using Pearson χ and Mann-Whitney tests. ORs were calculated to evaluate factors associated with STI co-infection prevalence.

RESULTS - Among 388 young women, STI co-infection prevalence was high: 47% had ≥2 concurrent STIs, 36% had a single STI and 17% had none of the five evaluated STIs. HPV/HSV-2 (26%) was the most prevalent co-infection detected followed by HPV/HSV-2/ (CT) (17%) and HPV/CT (15%). Co-infection prevalence was independently associated with alcohol use (adjusted OR=2.01, 95% CI 1.00 to 4.06) and having a sexual partner with an STI (adjusted OR=6.96, 95% CI 1.53 to 30.08).

CONCLUSIONS - Among high-risk young women from underserved communities such as in Southern Africa, a multicomponent prevention strategy that integrates medical and behavioural interventions targeting both men and women is essential to prevent acquisition of concurrent STI infections and consequent disease.

TRIAL REGISTRATION NUMBER - NCT01489527; Post-results.

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MeSH Terms (23)

Adolescent Alcohol Drinking Chlamydia trachomatis Coinfection Female Genotype Gonorrhea Herpes Genitalis Herpesvirus 2, Human HIV Infections HIV Seronegativity Humans Medically Underserved Area Papillomaviridae Papillomavirus Infections Papillomavirus Vaccines Prevalence Sexual Behavior Sexually Transmitted Diseases Sexual Partners South Africa Syphilis Young Adult

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