Abstract
BackgroundSexually transmitted infections (STIs) remain an important public health problem with approximately half a billion new cases annually among persons aged 15–49 years. Epidemiological data on STIs among women of reproductive age in Swaziland are limited. The availability of epidemiological data on STIs and associated risk factors in this population is essential for the development of successful prevention, diagnosis and management strategies in the country. The study aimed to determine the prevalence and risk factors associated with STIs.MethodsA total of 655 women aged 15–49 years were systematically enrolled from five health facilities using a cross-sectional study design. Cervical specimen were tested using GeneXpert CT/NG Assays for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), GeneXpertTV Assay for Trichomonas vaginalis (TV), and GeneXpert HPV Assays for hr-HPV. Blood samples were tested using Alere Determine HIV-1/2Ag/Ab Combo and Trinity Biotech Uni-Gold Recombigen HIV test for confirmation for HIV, and Rapid Plasma Reagin and TPHA test for confirmation for Treponema pallidum (syphilis). Genital warts were assessed prior to specimen collection. Survey weighted analyses were done to estimate the population burden of STIs.ResultsThe four most common curable STIs: CT, NG, TV, Treponema pallidum (syphilis), as well as genital warts were considered in this study. The overall weighted prevalence of any of these five STIs was 19.4% (95% CI: 14.9–24.8), corresponding to 72 990 women with STIs in Swaziland. The estimated prevalences were 7.0% (95% CI: 4.1–11.2) for CT, 6.0% (95% CI: 3.8–8.8) for NG, 8.4% (95% CI: 5.4–12.8) for TV, 1.4% (95% CI: 1.1–10.2) for syphilis and 2.0% (95% CI: 1.0–11.4) for genital warts. The overall weighted HIV prevalence was 42.7% (95%CI: 35.7–46.2). Among hr-HPV positive women, 18.8% (95% CI: 13.1–26.3) had one STI, while 6.3% (95% CI: 3.3–11.7) had multiple STIs. Risk factors associated with STIs were being employed (OR = 2.2, 95% CI: 1.0–4.7), self-employed (OR = 2.8, 95% CI: 1.5–5.5) and being hr-HPV positive (OR = 2.0, 95% CI: 1.3–3.1). Age (0.9, 95% CI: 0.8–0.9), being married (OR = 0.4, 95% CI: 0.3–0.7) and not using condoms with regular partners (OR = 0.5, 95% CI: 0.3–0.9) were inversely associated with STIs.ConclusionSTIs are highly prevalent among women of reproductive age in Swaziland. Thus, a comprehensive STIs screening, surveillance and treatment programme would be justified and could potentially lower the burden of STIs in the country.
Highlights
Transmitted infections (STIs) remain an important public health problem with approximately half a billion new cases annually among persons aged 15–49 years
Depending on which Sexually transmitted infections (STIs) and the population, in lowincome countries largely in sub-Saharan Africa (SSA), Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Human papillomavirus (HPV), herpes, and syphilis increase the risk of Human immunodeficiency virus (HIV) acquisition and transmission between two to eight fold [4, 6,7,8,9]
The impact of coinfection of HPV with HIV in the SSA has increased the burden of cervical diseases, since HIV infected women have a higher prevalence of hr-HPV [17]
Summary
Transmitted infections (STIs) remain an important public health problem with approximately half a billion new cases annually among persons aged 15–49 years. The study aimed to determine the prevalence and risk factors associated with STIs. Globally, sexually transmitted infections (STIs) remain a significant public health problem mainly in low-income countries [1, 2]. The World Health Organization (WHO) further estimated that 8.3, 21.1 and 59.7 million new cases of CT, NG and TV infections respectively, occur in sub-Saharan Africa (SSA), with the majority of new STIs occurring among the population aged 15 to 49 years [5]. Depending on which STI and the population, in lowincome countries largely in SSA, NG, CT, TV, Human papillomavirus (HPV), herpes, and syphilis increase the risk of HIV acquisition and transmission between two to eight fold [4, 6,7,8,9]. Impairments associated with STIs are a major cause of mother and child mortality and morbidity in adolescence and during pregnancy [18, 19]
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