Chlamydia and gonorrhea infections in HIV-positive women in urban Lusaka, Zambia (original) (raw)
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International Journal of STD & AIDS, 2020
Sexually transmitted infections (STIs) in women caused by Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG) are epidemiologically distinct. In this study, associations with sociodemographic and clinical risk factors are explored separately for CT and NG. Multivariate logistic regression (MLR) models quantify associations between potential CT and/or NG risk factors within a cross-sectional study of high-risk women in two Zambian cities, Lusaka and Ndola. CT was associated with living in Lusaka, younger age, and literacy. Long-acting reversible contraception (LARC) was predictive of CT in Ndola, but protective in Lusaka. In Lusaka only, CT was associated with lower education and reported unprotected sex. NG was associated with younger age, lower education, concurrent Trichomonas vaginalis, bacterial vaginosis, and incident syphilis infection. Signs and symptoms were rare and not associated with either infection. CT was more prevalent, nearly 11%, compared to NG, 6.8%. The h...
Sexually Transmitted Infections, 1997
Objectives: Few studies have evaluated the relation between male and female sexual behaviour and STD among married African women. The objectives of this study were to identify male and female sexual behaviour associated with female STD, and to explore whether incorporating male and female sexual behaviour and male symptoms can improve algorithms for STD management in married African women. Methods: 99 married couples with one symptomatic member (58 males, 41 females) attending an STD clinic in Lusaka, Zambia were interviewed separately about sexual and contraceptive behaviour, and had physical examinations. Diagnostic tests for Neisseria gonorrhoeae (GC), Trichomonas vaginalis (TV), and HIV were performed. Bivariate and multivariate odds ratios for the association between sexual behaviour and STD were calculated. Predictive algorithms based on current Zambian guidelines for management of STD in women were created. Results: Among women at baseline, 10% were positive for GC, 14% for TV, 52% for HIV. Female alcohol use before sex, a male's paying for sex, and a couple's having sex unprotected by condoms or spermicides were associated with female STD. Incorporation of these behaviours along with symptoms of urethral discharge and dysuria among husbands increased the predictive ability of algorithms for management of STD in women. Conclusions: The addition of male and female sexual behaviour and male STD symptoms to diagnostic algorithms for female STD should be explored in other settings. Both husbands' and wives' behaviour independently predict STD in these women; risk reduction programmes should target both men's and women's sexual behaviour.
Texila International Journal of Public Health, 2022
Sexually transmitted infections (STIs) are a public health problem globally. About 376 million new infections of the four main curable STIs are reported annually. In Zambia, as well as in many countries in sub-Saharan Africa, STIs are a major public health problem. Studies conducted mostly in the urban areas of Zambia show that the majority of young people engage in risky sexual behavior despite evidence suggesting widespread awareness about STIs. Therefore, the purpose of this study was to determine factors associated with STIs among women of child-bearing age in the Kabwe district, employing a cross-sectional study design. The sample size was 405, and data was collected using structured interview questionnaires. Bivariate and multivariate logistic regression using (SPSS) version 21 was used to analyze the data. The results showed that women engaged themselves in sexual activity at a much younger age of between 16-20 years. Despite women having a high level of knowledge of STIs, some still were involved in having more than one sexual partner, and this was statistically significant. Inconsistency in condom use by women was a risk factor in influencing a history of STI, and their attitudes showed that they have misconceptions regarding condom use, as some participants felt that condoms were not safe to use to prevent STIs during a sexual encounter. The current study, therefore, revealed that knowledge of STI alone is not adequate in providing protection from STI contraction and that behavioral factors must always be taken into consideration for any effective intervention.
Sexually Transmitted Diseases, 2011
Background: Uganda has long been successful in controlling the HIV epidemic; however, there is evidence that HIV prevalence and incidence are increasing again. Data on the HIV/STI epidemic among sex workers are so far lacking from Uganda. This paper describes the baseline epidemiology of HIV/STI in a newly established cohort of women involved in high-risk sexual behavior in Kampala, Uganda. Methods: Women were recruited from red-light areas in Kampala. Between April 2008 and May 2009, 1027 eligible women were enrolled. Sociodemographic and behavioral information were collected; blood and genital samples were tested for HIV/STI. Risk factors for HIV infection were examined using multivariate logistic regression. Results: HIV seroprevalence was 37%. The prevalence of Neisseria gonorrhoeae was 13%, Chlamydia trachomatis, 9%; Trichomonas vaginalis, 17%; bacterial vaginosis, 56% and candida infection, 11%. Eighty percent had herpes simplex virus 2 antibodies (HSV-2), 21% were TPHA-positive and 10% had active syphilis (RPRϩTPHAϩ). In 3% of the genital ulcers, Treponema pallidum (TP) was identified, Haemophilus ducreyi in 6%, and HSV-2 in 35%. Prevalent HIV was independently associated with older age, being widowed, lack of education, sex work as sole income, street-based sex work, not knowing HIV-status, using alcohol, and intravaginal cleansing with soap. HIV infection was associated with N. gonorrhoeae, T. vaginalis, bacterial vaginosis, HSV-2 seropositivity and active syphilis. Conclusions: Prevalence of HIV/STI is high among women involved in high-risk sexual behavior in Kampala. Targeted HIV prevention interventions including regular STI screening, voluntary HIV testing and counseling, condom promotion, and counseling for reducing alcohol use are urgently needed in this population.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013
Background-In 2008, the first clinic for women involved in high risk sexual behaviour was established in Kampala, offering targeted HIV prevention. This paper describes rates, determinants and trends of HIV incidence over 3 years. Methods-1027 women at high risk were enrolled into a closed cohort. At 3-monthly visits, data were collected on socio-demographic variables and risk behaviour; biological samples were tested for HIV and other STIs. Hazard ratios (HR) for HIV incidence were estimated using Cox proportional hazards regression, among the 646 women HIV negative at enrolment. Results-HIV incidence was 3.66/100pyr and declined from 6.80/100pyr in the first calendar year to 2.24/100pyr and 2.53/100pyr in the following years (P-trend=0.003). Socio-demographic and behavioural factors independently associated with HIV incidence were younger age, younger age at first sex, alcohol use (including frequency of use and binge drinking), number of paying clients in the past month, inconsistent condom use with clients, and not being pregnant. HIV incidence was also independently associated with M. genitalium infection at enrolment (aHR=2.28, 95%CI: 1.15-4.52), and with N. gonorrhoeae (aHR=5.91, 95%CI: 3.04-11.49) and T. vaginalis infections at the most recent visit (aHR=2.72, 95%CI: 1.27-5.84). The PAF of HIV incidence for alcohol use was 63.5% (95%CI 6.5%-85.8%), and for treatable STI/RTI was 70.0% (95%CI 18.8%-87.5%). Conclusions-Alcohol use and STIs remain important risk factors for HIV acquisition, which call for more intensive control measures in women at high risk. Further longitudinal studies are needed to confirm the association between Mycoplasma genitalium and HIV acquisition.
Ghana Medical Journal, 2011
To study the prevalence of genital chlamydia and gonococcal infections in women at risk of acquiring sexually transmitted infections in the Kumasi metropolis, Ghana. Design: Structured interviews and clinical examination of participants and obtaining vaginal swabs to test for gonorrhoea and chlamydia infections. Participants: Women aged between 18-35 years (inclusive) with a history of having at least 3 sexual acts per week and having had at least 2 sex partners in the previous 3 months and were willing to be part of the study. Results: One thousand and seventy (1070) women participated in the study. Genital chlamydia infection was found in 4.8% of participants whilst gonococcal infection was found in 0.9% of participants. Conclusion: The prevalence of genital chlamydia and gonococcal infections was low in these at-risk women. The prevalence is also lower than reported in other female populations in the country.
Bulletin of the World Health Organization, 1995
Sexually transmitted diseases (STDs) are a major cause of morbidity and mortality in developing countries and may play a key role in enhancing the heterosexual transmission of human immunodeficiency virus (HIV). Treatment of STDs is one of the most cost-effective of all public health interventions in developing countries; however, STDs among women in rural populations have received little attention. In this study, we report the prevalences of STDs among 964 women attending antenatal clinics in a rural area of the United Republic of Tanzania. A total of 378 (39%) of these women were infected with at least one STD pathogen, 97 (10%) had syphilis, and 81 (8%) had Neisseria gonorrhoeae (NG) and/or Chlamydia trachomatis (CT) infection. The recommended syndromic approach to screening for NG/CT infection, based on reported genital symptoms, had a low sensitivity (43%) and failed to discriminate between infected and uninfected women. A risk score approach that we developed, based on sociodemographic and other factors associated with NG/CT infection, had a higher sensitivity and lower cost per true case treated than other approaches, although its positive predictive value was only about 20%.
Sexually transmitted infections in HIV-infected patients in Kabale Hospital, Uganda
The Journal of Infection in Developing Countries, 2012
Introduction: Acquisition of sexually transmitted infections (STIs) is an epidemiological marker of high-risk sexual behavior in HIV-infected patients. We assessed the prevalence of STIs among patients attending an HIV care and support centre. Methodology: From January to August 2009, we assessed socio-demographic variables, sexuality, disclosure of sero-status and STI treatment for 400 patients attending the HIV care and support centre. Characteristics of those who had been treated and those who had never been treated for STIs were compared to identify factors independently associated with STIs. Results: Of the 400 respondents, 25.3% were male, 47.3% were aged 25-34 years, over 85% were currently married or had ever been married, and 62% had primary level of education or less. Though 82.5% were on antiretroviral drugs, only 53.1% disclosed their sero-status to their regular partners and only 41.9% knew the sero-status of their regular partners. Furthermore, 151 (37.7%) had been treated for STIs. The STIs were gonorrhoea (15; 9.7%), chlamydia (11; 7.1%), Trichomonas vaginalis (5; 3.3%), syphilis (99; 64.3%), and mixed infections (21; 13.6%). Factors associated with STI treatment on univariable analysis were age at sexual debut, whether the respondent had had sex in the previous six months, frequency of sexual intercourse, having changed sexual partners, number of sexual partners, and age when the respondent had a first child. Conclusion: Unprotected sexual intercourse and STIs are common among patients seeking HIV care in Uganda. Only the age of sexual debut (odds ratio0.82, confidence limits 0.71, 0.94) was independently (though inversely) associated with STIs.
Sexually Transmitted Diseases, 2009
Background-To assess the covariates of alcohol abuse and the association between alcohol abuse, high-risk sexual behaviors and sexually transmitted infections (STIs). Methods-2,019 women aged 20-44 were randomly selected in a two-stage sampling from the Moshi urban district of northern Tanzania. Participant's demographic and socioeconomic characteristics, alcohol use, sexual behaviors and STIs were assessed. Blood and urine samples were drawn for testing of human immunodeficiency virus, herpes simplex virus, syphilis, chlamydia, gonorrhea, trichomonas and mycoplasma genitalium infections. Results-Adjusted analyses showed that a history of physical (OR=2.05; 95% CI: 1.06-3.98) and sexual violence (OR=1.63; 95% CI: 1.05-2.51) was associated with alcohol abuse. Moreover, alcohol abuse was associated with number of sexual partners (OR=1.66; 95% CI: 1.01-2.73). Women who abused alcohol were more likely to report STIs symptoms (OR=1.61; 95% CI: 1.08-2.40). Women who had multiple sexual partners were more likely to have an STI (OR=2.41; 95% CI: 1.46-4.00) compared to women with one sexual partner. There was no direct association between alcohol abuse and prevalence of STIs (OR=0.86; 95% CI: 0.55-1.34). However, alcohol abuse was indirectly associated with STIs through its association with multiple sexual partners. Conclusions-The findings of alcohol abuse among physically and sexually violated women as well as the association between alcohol abuse and a history of symptoms of STIs and testing positive for STIs have significant public health implications. In sub-Saharan Africa, where women are disproportionately affected by the HIV epidemic screening for alcohol use should be part of comprehensive STIs and HIV prevention programs.