Population prevalence of sexually transmitted infections in a high HIV burden district in KwaZulu-Natal, South Africa: Implications for HIV epidemic control
•The high prevalence of STIs provides compelling evidence for enhanced surveillance for STI control.•Prevalence of curable STIs was higher in the younger age groups among whom a peak in HIV incidence occurs.•The association between STIs and HIV, HIV viral load ≥400 copies per mL contributes to susta...
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| Published in: | International journal of infectious diseases Vol. 98; pp. 130 - 137 |
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| Main Authors: | , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Canada
Elsevier Ltd
01-09-2020
Elsevier |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | •The high prevalence of STIs provides compelling evidence for enhanced surveillance for STI control.•Prevalence of curable STIs was higher in the younger age groups among whom a peak in HIV incidence occurs.•The association between STIs and HIV, HIV viral load ≥400 copies per mL contributes to sustaining the STI and HIV epidemics.•STIs threaten the goal of achieving HIV epidemic control in this high HIV burden region.
Sexually transmitted infections (STIs) and Human immunodeficiency virus (HIV) share a complex bidirectional relationship, however, population prevalence and the association between the presence of STIs and HIV in a high HIV burden district in KwaZulu-Natal, South Africa is not known.
A total of 9812 participants aged 15–49 years were enrolled in a cross-sectional population-based household survey. Participants completed a structured questionnaire and provided first-pass urine (males) or self-collected vulvo-vaginal swabs (females) for the detection of STIs.
Prevalence of herpes simplex virus type-2 (HSV-2) was 57.8%, syphilis was 1.6%, Neisseria gonorrhoeae was 2.8%, Chlamydia trachomatis was 7.1%, Trichomonas vaginalis was 9.0%, Mycoplasma genitalium was 5.5% and HIV was 36.3%. HIV positive status was associated with an increased probability of having M. genitalium (aPR = 1.49, 95% CI 1.02–2.19) among males and syphilis (aPR = 2.54, 95% CI 1.32–4.86), N. gonorrhoeae (aPR = 2.39, 95% CI 1.62–3.52), T. vaginalis (aPR = 1.70, 95% CI 1.43–2.01) and M. genitalium (aPR = 1.60, 95% CI 1.15–2.22) among females. HIV viral load ≥400 copies per mL was associated with an increased probability of N. gonorrhoeae (aPR = 1.91, 95% CI 1.36–2.70), C. trachomatis (aPR = 1.52, 95% CI 1.12–2.05) and M. genitalium (aPR = 1.83, 95% CI 1.27–2.63).
The high prevalence of STIs and the association between STIs and HIV, and HIV viral load underscores the public health implications of sustained transmission risk of STIs and HIV. These findings highlight the urgent need for expanding STI surveillance and implementing interventions to monitor and reduce the STI burden. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ABMK is the principal investigator of the study and wrote the manuscript. ABMK, LRM and LL were responsible for analysis and interpretation of the data. TCG contributed with the preparation of the tables and the literature review. ABMK, CC and DK were responsible for the field work and quality assurance; DVM was responsible for the laboratory measurements and quality assurance, SB, KG and GG contributed to the household and individual level data collection tools and interpretation of the data; DK, CC and ABMK were responsible for community and stakeholder engagement activities; KAA and CT contributed to the interpretation of the data. All authors critically reviewed and approved the final version of the manuscript. Author contributions |
| ISSN: | 1201-9712 1878-3511 |
| DOI: | 10.1016/j.ijid.2020.06.046 |