Epidemiology of {Curable} {Sexually} {Transmitted} {Infections} among {Women} at {Increased} {Risk} for {HIV} in {Northwestern} {Tanzania:} {Inadequacy} of {Syndromic} Management

  • uzanna C. . Francis S
  • rong T. . Ao T
  • iona M. . Vanobberghen F
  • et al.
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Background: Curable, non-viral pathogens account for a<br />significant burden of sexually transmitted infections (STIs), and<br />there is established evidence that STIs increase both HIV<br />acquisition and transmission. We investigated the prevalence,<br />trends, and factors associated with Chlamydia trachomatis,<br />Neisseria gonorrhoeae, Trichomonas vaginalis and Treponema<br />pallidum, and the performance of syndromic management, among a<br />cohort of women working in bars, hotels, and other food and<br />recreational facilities near large-scale mines in northwestern<br />Tanzania. Methods: HIV-negative women aged 18-44 years (N = 966)<br />were enrolled and followed for 12 months in a microbicides<br />feasibility study. We collected sociodemographic and behavioural<br />data, performed clinical examinations, and tested for STIs, at<br />enrolment and 3-monthly. Risk factors for STIs were investigated<br />using logistic regression models with random effects. Sensitivity,<br />specificity and predictive values of syndromic management were<br />calculated. Results: At enrolment, the prevalences of C.<br />trachomatis, N. gonorrhoeae, T. vaginalis, and high-titre active<br />syphilis were 111/956 (12%), 42/955 (4%), 184/945 (19%) and 46/965<br />(5%), respectively. There were significant decreases over time for<br />C. trachomatis and T. vaginalis (OR trend per month: 0.94 [95% CI<br />0.91, 0.97]; and 0.95 [0.93, 0.98], respectively; both p < 0.001).<br />The majority of these infections were not diagnosed by the<br />corresponding syndrome; therefore, most participants were not<br />treated at the diagnosis visit. Syndromic management was poorly<br />predictive of laboratory-diagnosed infections. We identified a<br />number of risk factors for STIs, including low educational level,<br />some sexual behaviours, and ever having been pregnant.<br />Conclusions: This analysis demonstrates that the prevalences of<br />curable STIs are high among women who work in food and<br />recreational facilities in northwestern Tanzania. Most of these<br />infections are missed by syndromic management. Accurate and<br />affordable rapid-point-of-care tests and innovative interventions<br />are needed to reduce the burden of STIs in this population which<br />is at increased risk for HIV.




uzanna C. . Francis, S., rong T. . Ao, T., iona M. . Vanobberghen, F., oseph Chilongani, J., amadhan Hashim, R., ura Andreasen, A., … ichard J. . Hayes, R. (2014). Epidemiology of {Curable} {Sexually} {Transmitted} {Infections} among {Women} at {Increased} {Risk} for {HIV} in {Northwestern} {Tanzania:} {Inadequacy} of {Syndromic} Management. Plos One, 9(7), e101221.

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