Risk factors for sexually transmitted diseases among women attending family planning clinics in Dar-es-Salaam, Tanzania

High prevalence and incidence of sexually transmitted infections among women living in Kwazulu-Natal, South Africa

BACKGROUND AND OBJECTIVES

Sexually transmitted infections (STIs) contribute largely to the burden of health in South Africa and are recognized as major contributors to the human immunodeficiency virus (HIV) epidemic. Young women are particularly vulnerable to STIs. The purpose of this secondary analysis was to examine the risk factors associated with prevalent and incident STIs among women who had participated in three clinical trials.

METHODS

A total of 5,748 women were screened and 2293 sexually active, HIV negative, non-pregnant women were enrolled in three clinical trials in Kwazulu-Natal, South Africa. The prevalence of individual STIs Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), syphilis, and Trichomonas vaginalis (TV) was assessed at screening; and incident infections were evaluated over a 24 month period.

RESULTS

Overall, the combined study population of all three trials had a median age of 28 years (inter-quartile range (IQR):22-37), and a median duration of follow-up of 12 months. Prevalence of STIs (CT, NG, TV, or syphilis) was 13% at screening. The STI incidence was estimated to be 20/100 women years. Younger women (<25 years, p < 0.001), women who were unmarried (p < 0.001) and non-cohabiting women (p < 0.001) were shown to be at highest risk for incident STIs.

CONCLUSIONS

These results confirm the extremely high prevalence and incidence of STIs among women living in rural and urban communities of KwaZulu-Natal, South Africa, where the HIV epidemic is also particularly severe. These findings strongly suggest an urgent need to allocate resources for STI and HIV prevention that mainly target younger women.

TRIAL REGISTRATION

Clinical Trials.gov, NCT00121459.

Parasitism and the evolutionary ecology of animal personality

The ecological factors responsible for the evolution of individual differences in animal personality (consistent individual differences in the same behaviour across time and contexts) are currently the subject of intense debate. A limited number of ecological factors have been investigated to date, with most attention focusing on the roles of resource competition and predation. We suggest here that parasitism may play a potentially important, but largely overlooked, role in the evolution of animal personalities. We identify two major routes by which parasites might influence the evolution of animal personality. First, because the risk of acquiring parasites can be influenced by an individual's behavioural type, local parasite regimes may impose selection on personality traits and behavioural syndromes (correlations between personality traits). Second, because parasite infections have consequences for aspects of host 'state', parasites might induce the evolution of individual differences in certain types of host behaviour in populations with endemic infections. Also, because infection often leads to specific changes in axes of personality, parasite infections have the potential to decouple behavioural syndromes. Host-parasite systems therefore provide researchers with valuable tools to study personality variation and behavioural syndromes from a proximate and ultimate perspective.

Correlates of syphilis seroreactivity among pregnant women: the HIVNET 024 Trial in Malawi, Tanzania, and Zambia

OBJECTIVES

The objectives of this cross-sectional study were to determine correlates of syphilis seroprevalence among HIV-infected and -uninfected antenatal attendees in an African multisite clinical trial, and to improve strategies for maternal syphilis prevention.

RESULTS

A total of 2,270 (86%) women were HIV-infected and 366 (14%) were HIV-uninfected. One hundred seventy-five (6.6%) were syphilis-seropositive (7.3% among HIV-infected and 2.6% HIV-uninfected women). Statistically significant correlates included geographic site (odds ratio [OR] = 4.5, Blantyre; OR = 3.2, Lilongwe; OR = 9.0, Lusaka vs. Dar es Salaam referent); HIV infection (OR = 3.3); age 20 to 24 years (OR = 2.5); being divorced, widowed, or separated (OR = 2.9); genital ulcer treatment in the last year (OR = 2.9); history of stillbirth (OR = 2.8, one stillbirth; OR = 4.3, 2-5 stillbirths); and history of preterm delivery (OR = 2.7, one preterm delivery).

CONCLUSION

Many women without identified risk factors were syphilis-seropositive. Younger HIV-infected women were at highest risk. Universal integrated antenatal HIV and syphilis screening and treatment is essential in sub-Saharan African settings.

Sexually transmitted infections among married women in Dhaka, Bangladesh: unexpected high prevalence of herpes simplex type 2 infection

OBJECTIVES

To document the prevalence of reproductive tract infections (RTI) and sexually transmitted infections (STI) among women attending a basic healthcare clinic in Dhaka, Bangladesh, to identify risk factors associated with the diseases and to estimate the incidence of syphilis, hepatitis C (HCV), hepatitis B (HBV), and herpes simplex type 2 (HSV-2) infection.

METHODS

A cross sectional sample of 2335 consecutive women was examined during 1996-8. Women were interviewed about risk factors for RTI/STI and tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Treponema pallidum, HIV, HCV, HBV, HSV-1 and HSV-2 infection as well as vaginal candidosis and bacterial vaginosis. Women with antibodies to T pallidum were retested at regular intervals. One year after ending the study seroconversion for syphilis, HBV, HCV, and HSV-2 infection was detected among women initially negative for the respective diseases.

RESULTS

The overall prevalence rate of N gonorrhoeae, C trachomatis, T vaginalis, and T pallidum infection was 0.5%, 1.9%, 2.0%, and 2.9% respectively. Overall, 35% of the women had antibodies to hepatitis B core antigen, 0.9% had HCV, and 12% HSV-2 infection. Risk factors for gonorrhoea/C trachomatis infection were a husband not living at home or suspected of being unfaithful. HSV-2 infection was associated with the same risk factors and with a polygamous marriage. The prevalence of HSV-2 infection among women "at risk" was 23%. HIV infection was not diagnosed. Repeated serological examination indicated that only 32% of women with serological evidence of syphilis had active disease. The seroincidences of HBV, HCV, and HSV-2 were 0.03, 0.007, and 0.009 per person year. Seroconversion for syphilis was not observed.

[Prevalence of vaginal candidiasis in a low-risk obstetric population in Santander]

OBJECTIVES

To find the prevalence of vaginal candidiasis in pregnant women monitored through primary care and to see whether it is on the increase.

DESIGN

Descriptive and retrospective study of pregnant women.

SETTING

Cazoña Health District (34,783 inhabitants).

SUBJECTS

The entire obstetric population monitored by our health centre between 1992 and 1997 inclusive.

MEASUREMENTS AND RESULTS

Retrospective study of clinical histories of all the pregnant women seen at our health centre (878 pregnancies). After discounting those referred to obstetricians, abortions/miscarriages and premature births, 549 normal low-risk pregnancies (62.30% of the total) were monitored to completion in primary care. The women's age range was 16 to 40. The mean prevalence of candidiasis was 18% (CI, 15.0-21.6). Its frequency increased as the number of pregnancies increased and dropped as the age of the pregnant women increased.

CONCLUSIONS

Prevalence found in our study was 18% and did not increase as the years passed.

The prevalence of sexually transmitted pathogens in patients presenting to a Casablanca STD clinic

The objective of this study conducted at the sexually transmitted diseases (STD) clinic of the Pasteur Institute of Morocco (SCPIM) is to describe clinical complaints and biological findings in patients attending this facility. Two thousand two hundred sixty-four patients had visited the STD clinic from 1992 to 1996. The main reported symptom was genital discharge for men (44.5%) and women (68.6%). Genital eruption and ulcer were more frequent in men. The principal biological result shows a seroprevalence of 0.62% for human immunodeficiency virus (HIV), 3.05% for hepatitis B virus (HBV), 51.5% for chlamydiae and 13.2% for syphilis. Factors associated with clinical findings were age and Gonococcus for men (odds ratio (OR): 1.94 and 5.96, respectively) and Trichomonas and positive TPHA for women (OR: 9.49 and 0.25, respectively). This work describes for the first time the distribution of various germs involved in sexually transmitted diseases in Moroccan population and underlines the importance of studying its sexual behavior as well as determinants of STD incidence.