Prevalence and incidence of sexually transmitted infections among South African women initiating injectable and long-acting contraceptives

Author:

Harryparsad Rushil,Meyer Bahiah,Taku Ongeziwe,Serrano Myrna,Chen Pai Lien,Gao Xiaoming,Williamson Anna-Lise,Mehou-Loko Celia,d’Hellencourt Florence Lefebvre,Smit Jennifer,Strauss JeromeORCID,Nanda Kavita,Ahmed KhatijaORCID,Beksinska Mags,Buck Gregory,Morrison Charles,Deese Jennifer,Masson LindiORCID

Abstract

Background South Africa is among the countries with the highest prevalence of sexually transmitted infections (STIs), including Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). In 2017, there were an estimated 6 million new CT, 4.5 million NG and 71 000 Treponema pallidum infections among South African men and women of reproductive age. Methods We evaluated STI prevalence and incidence and associated risk factors in 162 women aged 18–33 years old, residing in eThekwini and Tshwane, South Africa who were part of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial. Women were randomised to use depot medroxyprogesterone acetate (n = 53), copper intrauterine device (n = 51), or levonorgestrel (n = 58) implant. Lateral vaginal wall swab samples were collected prior to contraceptive initiation and at months one and three following contraceptive initiation for STI testing. Results There were no significant differences in STI incidence and prevalence across contraceptive groups. At baseline, 40% had active STIs (CT, NG, Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) or herpes simplex virus-2 shedding across all age groups– 18–21 years (46%), 22–25 years (42%) and 26–33 years (29%). The incidence of STIs during follow-up was exceptionally high (107.9/100 women-years [wy]), with younger women (18–21 years) more likely to acquire CT (75.9/100 wy) compared to 26–33 year olds (17.4/100 wy; p = 0.049). TV incidence was higher in the 26–33 year old group (82.7/100 wy) compared to the 18–21 year olds (8.4/100 wy; p = 0.01). Conclusions Although the study participants received extensive counselling on the importance of condom use, this study highlights the high prevalence and incidence of STIs in South African women, especially amongst young women, emphasising the need for better STI screening and management strategies.

Funder

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Carnegie Corporation of New York

South African National Research Foundation

Australian National Health and Medical Research Council

Bill and Melinda Gates Foundation

United States Agency for International Development

Swedish International Development Cooperation Agency

South Africa Medical Research Council

United Nations Population Fund

Publisher

Public Library of Science (PLoS)

Subject

Multidisciplinary

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