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. 2023 Nov;99(7):433-439.
doi: 10.1136/sextrans-2022-055696. Epub 2023 Mar 8.

High prevalence and incidence of gonorrhoea and chlamydia in young women eligible for HIV pre-exposure prophylaxis in South Africa and Zimbabwe: results from the HPTN 082 trial

Sinead Delany-Moretlwe  1 , Nyaradzo Mgodi  2 , Linda-Gail Bekker  3 , Jared M Baeten  4   5 , Chuwen Li  6 , Deborah Donnell  6 , Yaw Agyei  7 , Denni Lennon  7 , Scott M Rose  8 , Marcia Mokgatle  9 , Sheetal Kassim  3 , Shorai Mukaka  2 , Adeola Adeyeye  10 , Connie Celum  4
Affiliations

High prevalence and incidence of gonorrhoea and chlamydia in young women eligible for HIV pre-exposure prophylaxis in South Africa and Zimbabwe: results from the HPTN 082 trial

Sinead Delany-Moretlwe et al. Sex Transm Infect. 2023 Nov.

Abstract

Introduction: We investigated the prevalence, incidence and factors associated with sexually transmitted infections (STIs) among young African women seeking HIV pre-exposure prophylaxis (PrEP).

Methods: HPTN 082 was a prospective, open-label PrEP study enrolling HIV-negative sexually active women aged 16-25 years in Cape Town and Johannesburg, South Africa, and Harare, Zimbabwe. Endocervical swabs from enrolment, months 6 and 12 were tested for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) by nucleic acid amplification, and Trichomonas vaginalis (TV) by a rapid test. Intracellular tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots were measured at months 6 and 12. Associations between risk characteristics and STI outcomes were assessed using Poisson regression.

Results: Of 451 enrolled participants, 55% had an STI detected at least once. CT incidence was 27.8 per 100 person-years (py) (95% CI 23.1, 33.2), GC incidence was 11.4 per 100 py (95% CI 8.5, 15.0) and TV incidence was 6.7 per 100 py (95% CI 4.5, 9.5). 66% of incident infections were diagnosed in women uninfected at baseline. Baseline cervical infection (GC or CT) risk was highest in Cape Town (relative risk (RR) 2.38, 95% CI 1.35, 4.19) and in those not living with family (RR 1.87, 95% 1.13, 3.08); condom use was protective (RR 0.67, 95% CI 0.45, 0.99). Incident CT was associated with baseline CT (RR 2.01; 95% CI 1.28, 3.15) and increasing depression score (RR 1.05; 95% CI 1.01, 1.09). Incident GC was higher in Cape Town (RR 2.40; 95% CI 1.18, 4.90) and in participants with high PrEP adherence (TFV-DP concentrations ≥700 fmol/punch) (RR 2.04 95% CI 1.02, 4.08).

Conclusion: Adolescent girls and young women seeking PrEP have a high prevalence and incidence of curable STIs. Alternatives to syndromic management for diagnosis and treatment are needed to reduce the burden of STIs in this population.

Trial registration number: NCT02732730.

Keywords: AFRICA; Chlamydia Infections; Gonorrhea; Pre-Exposure Prophylaxis.

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Conflict of interest statement

Competing interests: None declared.

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References

    1. UNAIDS . The gap report. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS, 2014: 24–6.
    1. Rowley J, Vander Hoorn S, Korenromp E, et al. . Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019;97:548–562P. 10.2471/BLT.18.228486 - DOI - PMC - PubMed
    1. Unemo M, Bradshaw CS, Hocking JS, et al. . Sexually transmitted infections: challenges ahead. Lancet Infect Dis 2017;17:e235–79. 10.1016/S1473-3099(17)30310-9 - DOI - PubMed
    1. Haggerty CL, Gottlieb SL, Taylor BD, et al. . Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis 2010;201 Suppl 2:S134–55. 10.1086/652395 - DOI - PubMed
    1. Ness RB, Soper DE, Holley RL, et al. . Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the pelvic inflammatory disease evaluation and clinical health (peach) randomized trial. Am J Obstet Gynecol 2002;186:929–37. 10.1067/mob.2002.121625 - DOI - PubMed

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