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

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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Figures

Figure 1:

STI coinfection patterns among HIV-negative young South African women in the EVRI trial with one or more STIs (CT=Chlamydia, GC=Gonorrhea, SY=Syphilis, HSV=Herpes Simplex-2, HPV=disease causing HPV genotypes, specifically genital warts (HPV 6, 11) and cervical cancer (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68). A, Pattern of infections: no infection, single infection and coinfections; B, Pattern of single infections among women with one of the five evaluated STIs; C, Coinfection patterns among women with concurrent STIs

Figure 2.

Prevalence of coinfectionsa among South African young women with at least one of the five STIs (HPVb, chlamydia, gonorrhea, syphilis, HSV-2) (n=321). aFor example, among the 23 women that had syphilis detected, 4 (17%) had a single infection, 6 (26%) were coinfected with syphilis and another STI, 9 (39%) were coinfected with syphilis and two other STIs, 3 (13%) were coinfected with syphilis and three other STIs and 1(4%) was coinfected with syphilis and all four other STIs. bHPV genotypes known to cause disease specifically genital warts (HPV 6, 11) and cervical cancer (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)