Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa

Elisabeth Kleppa, Sigve D Holmen, Kristine Lillebø, Eyrun F Kjetland, Svein Gunnar Gundersen, Myra Taylor, Prashini Moodley, Mathias Onsrud, Elisabeth Kleppa, Sigve D Holmen, Kristine Lillebø, Eyrun F Kjetland, Svein Gunnar Gundersen, Myra Taylor, Prashini Moodley, Mathias Onsrud

Abstract

Objectives: It has been hypothesised that ectopy may be associated with increased susceptibility to sexually transmitted infections (STIs). In this cross-sectional study, we wanted to explore the association between STIs (including HIV) and cervical ectopy.

Methods: We included 700 sexually active young women attending randomly selected high schools in a rural district in KwaZulu-Natal, South Africa. The district is endemic of HIV and has a high prevalence of STIs. We did computer-assisted measurements of the ectocervical area covered by columnar epithelium (ectopy) in colposcopic images and STI analyses on cervicovaginal lavage and serum samples. All participating women answered a questionnaire about sexual behaviour and use of contraceptives.

Results: The mean age was 19.1 years. Ectopy was found in 27.2%, HIV in 27.8%, chlamydia in 25.3% and gonorrhoea in 15.6%. We found that age, parity, chlamydia and gonorrhoea, years since menarche, years since sexual debut and number of sexual partners were associated with ectopy. In multivariate analysis with chlamydia infection as the dependent variable, women with ectopy had increased odds of having chlamydia infection (adjusted OR 1.78, p=0.033). In women under 19 years of age, we found twofold higher odds of being HIV-positive for those with ectopy (OR 2.19, p=0.014).

Conclusions: In conclusion, cervical ectopy is associated with Chlamydia trachomatis infection and HIV in the youngest women.

Keywords: ADOLESCENT; AFRICA; CHLAMYDIA INFECTION; ECTOPY; HIV.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Flowchart showing inclusion of images.
Figure 2
Figure 2
A photocolposcopic image of the ectocervix. Solid line: Delimiting the cervical area. Dashed line: Original squamocolumnar junction, outer delimitation of the transformation zone. Dotted line: Current squamocolumnar junction, represents the border between columnar epithelium and metaplastic squamous epithelium in the transformation zone.
Figure 3
Figure 3
Graph showing the OR, with 95% CIs, of having Chlamydia trachomatis infection (y-axis) with increasing levels of cervical ectopy (x-axis). Participants without ectopy (<10%) serve as the reference group.

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