Page 386 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 5 of 6 Original Research

synergistic co-pathogens. The parallel intersecting epidemics survey any additional anatomical sites; consequently, the
of the HIV and HSV infections are well documented, and results for this study focus on vaginal and cervical STIs
studies indicate that HSV 2 plays an important role in the (except for syphilis). Women were asked to report historical
spread of HIV and affects virological control of the coinfected events which may introduce recall bias particularly relating
untreated patient. 28 to number of sexual partners and condom use.

Analysis from this study suggests that women with less In conclusion, we have reported a high prevalence of non-
formal education were more likely to be diagnosed with an viral STIs in a cohort of largely asymptomatic HIV-infected
STI; this is consistent with findings from other similar studies. women. Those reporting more than three lifetime partners
Quinlivan et al. found a five-fold increase in risk of infection and with less formal education were at higher risk of STI
with TV in women living with HIV with low reported acquisition. The major strategy in most resource-poor settings
education status. Suggested explanations for this commonly for STI control is focused on syndromic management of
22
reported observation are that lesser educated women are less genitourinary infections. Although we recognise this is an
likely to be employed and therefore are more dependent on important public health measure, this hidden epidemic may
their sexual partners or more likely to engage in transactional be associated with significant morbidity and drives onward
sex. Negotiating safe sex in both these situations may be HIV transmission. STI control remains an important aspect
more challenging. 29,30
of HIV prevention. These results emphasise the need for
identification of high-risk women through routine sexual
Multivariate analysis revealed that women reporting more history checking and targeted aetiological screening of high-
than three lifetime sexual partners were three times as likely risk individuals for asymptomatic STIs. There is an increased
to be diagnosed with a non-viral STI. Taking a thorough role for diagnostic technology which can be used for
sexual history is an important tool in risk profiling of patients, surveillance and STI screening of at-risk women. Polymerase
and in countries where resources are limited, it can enable chain reaction and point-of-care diagnostic technology need
healthcare professionals to target high-risk patients for
targeted screening. Participants in this study were not to be included as part of rapid STI treatment modalities.
recruited based on symptoms. However, on completion of a
detailed sexual history, 13.0% of women reported ongoing Acknowledgements
symptoms consistent with an STI diagnosis. Possible reasons Competing interests
for participants delaying in seeking treatment include stigma The authors declare that they have no financial or personal
31
associated with an STI diagnosis. The level of education relationships that may have inappropriately influenced them
attained by an individual may also have a bearing on whether in writing this article.
they will seek treatment as they may not be in a position to
relate ongoing symptoms to a possible STI diagnosis. This is
of importance in countries like Zimbabwe where STI treatment Authors’ contributions
programmes focus on syndromic management approach. S.L. was responsible for the conception of the study and its
design, drafting of the manuscript and analysis of data. P.M.
The prevalence of previous or current sexual abuse and/or was responsible for data collection. M.P. supervised the
intimate partner violence (IPV) was reported in this study. research process and contributed to the analysis of the data
Our results are consistent with published data reporting a and write-up. A.M. was responsible for managing the study
strong association between IPV and HIV infection. Studies data, follow-up of patients and assisted with the write-up.
32
from Tanzania and Rwanda report that women experiencing T.M., T.S., R.L. and C.C. assisted with study conception, data
IPV are up to three times more likely to acquire HIV. 33,34 analysis and write-up. All the authors revised the draft
Studies also report an association between sexual abuse in critically and gave final approval of the version to be
childhood and increased sexual risk behaviours in adulthood published. All authors read and approved the final manuscript.
35
leading to higher rates of STIs, including HIV. Importantly,
many of the women in the study had not previously References
disclosed this sensitive information despite long-term and
recurrent attendance at a health facility, highlighting the 1. Dallabetta G, Field ML, Lage M, Islam QM. STDs: Global burden and challenges
for control. In: Dallabetta G, Laga M, Lamptey P, editors. Control of sexually
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2. World Health Organization. Sexually transmitted infections. Fact sheet no. 110.
This study highlights an unrecognised burden of STIs and 2016. Available from: http://apps.who.int/iris/bitstream/handle/10665/82207/
who_rhr_13.02_eng.pdf
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important limitation of the study is, however, the lack of and incidence of four curable sexually transmitted infections in 2012 based
on systematic review and global reporting. PLoS One. 2015;10(12):e0143304.
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HIV treatment for prevention: History of sexually transmitted coinfections
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http://www.sajhivmed.org.za 379 Open Access