Abstract
The anogenital prevalence of sexually transmitted infections (STIs) and the use of cervico-vaginal self-collected vs. clinician-collected samples were evaluated for the diagnosis of human immunodeficiency virus (HIV)-infected and HIV-uninfected women in the Tapajós region, Amazon, Brazil. We recruited 153 women for a cross-sectional study (112 HIV-uninfected and 41 HIV-infected) who sought health services. Anal and cervical scrapings and cervico-vaginal self-collection samples were collected. Real-time polymerase chain reaction methods were used for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. A syphilis test was also performed. Risk factors for STIs were identified by multivariate analysis. The overall prevalence of STIs was 30.4% (34/112) in HIV-uninfected women and 24.4% (10/41) in HIV-infected women. Anogenital Chlamydia trachomatis infection was the most prevalent in both groups of women (20.5% vs 19.5%). There was significant agreement for each STI between self-collected and clinician-collected samples: 91.7%, kappa 0.67, 95% confidence interval (CI) 0.49–0.85 for Chlamydia trachomatis; 99.2%, kappa 0.85, 95% CI 0.57–1.00 for Neisseria gonorrhoeae; 97.7%, kappa 0.39, 95% CI -0.16–0.94 for Trichomonas vaginalis; and 94.7%, kappa 0.51, 95% CI 0.20–0.82 for Mycoplasma genitalium. Women with human papillomavirus had coinfection or multiple infections with other STIs. Risk factors for STIs were being ≤ 25 years old, being employed or a student, reporting a history of STI and having a positive HPV test. A high prevalence of STIs in women in the Tapajós region was found. Cervico-vaginal self-collection is a useful tool for STI screening and can be used in prevention control programs in low-resource settings, such as in northern Brazil.
Highlights
The World Health Organization (WHO) estimates that among adults aged 15–49 years there are 357 million new infections each year of either Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) or syphilis
The aim of this study was to determine the anogenital prevalence of STIs and to evaluate the use of cervico-vaginal self-collection versus clinician-collection samples for STI diagnosis in human immunodeficiency virus (HIV)-infected and HIV-uninfected women living in the Tapajos region, Amazon, Brazil
The cross-sectional study was conducted from August 2015 to August 2016 and included nonindigenous, HIV-infected and HIV-uninfected women living in the Tapajos region
Summary
The World Health Organization (WHO) estimates that among adults aged 15–49 years there are 357 million new infections each year of either Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) or syphilis. This represents approximately one million new infections every day [1]. Some isolated studies in Brazil show a varied prevalence of STIs that depends on the infectious agent, population approached, sample size and laboratory techniques used [5,6]. In the Amazon, accessibility, measured as the travel time via local transportation to a public health unit, remains a challenge for health care access, as well as for scientific research in these places [8], and this may be why there are very few studies on STIs in northern Brazil
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