Page 382 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 6 Original Research

Sexually transmitted infections, the silent partner

in HIV-infected women in Zimbabwe

Authors: Background: Coinfection rates of HIV and sexually transmitted infections (STIs) are not
Sara Lowe widely reported in Zimbabwe and no local guidelines regarding the screening of STIs in people
1,2
Tinashe Mudzviti
3,4
Ardele Mandiriri 3 living with HIV exist.
Tinei Shamu 3
Petronella Mudhokwani 3 Objectives: This cross-sectional study was conducted to determine the prevalence and
Cleophas Chimbetete 3 associated risk factors for STI coinfection in a cohort of HIV-infected women.
Ruedi Luethy 3
Margaret Pascoe 3 Methods: Between January and June 2016, 385 HIV-infected women presenting for routine
cervical cancer screening were tested for five STIs: Neisseria gonorrhoeae (NG), Chlamydia
Affiliations: trachomatis (CT), Trichomonas vaginalis (TV), Herpes Simplex Virus (HSV) type 2 and
1 AIDS Healthcare Foundation, Treponema pallidum (TP). Socio-demographic characteristics and sexual history were recorded.
Parirenyatwa Centre of
Excellence, Parirenyatwa Multiple logistic regression was used to identify factors associated with the diagnosis of
Hospital, Zimbabwe non-viral STIs.
2 Department of Medicine, Results: Two hundred and thirty-three participants (60.5%) had a confirmed positive result for
College of Health Sciences, at least one STI: HSV 2 prevalence 52.5%, TV 8.1%, CT 2.1%, NG 1.8% and TP 11.4%. Eighty-
University of Zimbabwe, seven per cent of the women were asymptomatic for any STI; 62.3% of women with a non-viral
Zimbabwe STI were asymptomatic. Women who had attended tertiary education were 90% less likely to
have a non-viral STI (adjusted odds ratio [aOR]: 0.10, 95% confidence interval [CI]: 0.03–0.39,
3 Newlands Clinic, Zimbabwe
p < 0.01). Having more than three lifetime sexual partners was a significant predictor for a non-
4 School of Pharmacy, College viral STI diagnosis (aOR: 3.3, 95% CI: 1.5–7.2, p < 0.01).
of Health Sciences, University
of Zimbabwe, Zimbabwe Conclusion: A high prevalence of predominantly asymptomatic STIs is reported in a cohort
of HIV-infected women. Syndromic management results in underdiagnosis of asymptomatic
Corresponding author: patients. More than three lifetime sexual partners and less formal education are risk factors
Sara Lowe, for coinfection with non-viral STI. High-risk women should be screened using aetiological
[email protected]
methods.
Dates:
Received: 12 Mar. 2018
Accepted: 13 Sept. 2018 Introduction
Published: 23 Jan. 2019
Sexually transmitted infections (STIs) and their many sequelae are among the top five reasons
How to cite this article: that adults seek healthcare in low-income settings. The World Health Organization reports that
1
Lowe S, Mudzviti T, Mandiriri A,
et al. Sexually transmitted worldwide more than one million STIs are acquired each day and an estimated 340 million curable
infections, the silent partner bacterial STIs per year. Viral infections constitute a large proportion of prevalent STIs with an
in HIV-infected women in estimated 536 million people living with Herpes Simplex Virus (HSV) and 291 million women
Zimbabwe. S Afr J HIV Med. with Human Papilloma Virus (HPV) infection at any point in time, with the numbers in men
2019;20(1), a849. https://doi.
2
org/10.4102/sajhivmed. likely to be similar. Adverse events associated with untreated STIs are common: neonatal
v20i1.849 morbidity and mortality; infertility; ectopic pregnancy and increased risk of transmission of the
Human Immunodeficiency Virus (HIV) are all important sequelae. These under recognised STI
Copyright:
© 2019. The Authors. epidemics constitute a significant global public health threat and have a profound impact on
Licensee: AOSIS. This work quality of life, particularly among people aged 15–49 years. 3
is licensed under the
Creative Commons HIV and STIs share a complex bidirectional relationship. STIs increase HIV viral shedding in the
Attribution License.
genital tract, resulting in significant increases in HIV transmission risk. Local inflammation
activates HIV replication in the genital compartment independent of HIV in peripheral blood. An
individual may have an undetectable plasma HIV viral load (VL), while the genital tract VL is
elevated. It has been shown that the presence of both ulcerative and non-ulcerative STIs
4
5
Read online: significantly increases the risk of both acquiring and transmitting HIV. In systematic reviews
Read online:
6
7
Scan this QR
Scan this QR conducted by Fleming and Wasserheit and Kalichman et al., both groups concluded that HIV
code with your
code with your transmission was facilitated by the presence of other STIs, whether symptomatic or asymptomatic,
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smart phone or
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mobile device and that early STI diagnosis and treatment should be part of a high-quality, comprehensive HIV
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prevention strategy. 6,7,8
http://www.sajhivmed.org.za 375 Open Access