Patterns of prevalent HPV and STI co-infections and associated factors among HIV-negative young Western Cape, South African women: the EVRI trial
Lynette J Menezes, Ubin Pokharel, Staci L Sudenga, Matthys H Botha, Michele Zeier, Martha E Abrahamsen, Richard H Glashoff, Susan Engelbrecht, Maarten F Schim van der Loeff, Louvina E van der Laan, Siegfried Kipping, Douglas Taylor, Anna R Giuliano, Lynette J Menezes, Ubin Pokharel, Staci L Sudenga, Matthys H Botha, Michele Zeier, Martha E Abrahamsen, Richard H Glashoff, Susan Engelbrecht, Maarten F Schim van der Loeff, Louvina E van der Laan, Siegfried Kipping, Douglas Taylor, Anna R Giuliano
Abstract
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 χ2 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/Chlamydia trachomatis (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.
Keywords: CHLAMYDIA INFECTION; GONORRHOEA; HPV; HSV; SYPHILIS.
Conflict of interest statement
Competing interests: ARG is a member of Merck research advisory boards. ARG and SLS received research funding from Merck. MFSvdL received research funding from Sanofi-Pasteur MSD; he is a co-investigator in a Sanofi-Pasteur-MSD HPV vaccine trial; he sat on a vaccine advisory board of GSK; his institution received in-kind contribution for an HPV study from Stichting Pathologie Onderzoek en Ontwikkeling; his institution receives research funding from Janssen Infectious Diseases and Vaccines.
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Source: PubMed