HIV-1, HSV-2 and syphilis among pregnant women in a rural area of Tanzania: prevalence and risk factors.
BACKGROUND
Evidence suggests that a substantial proportion of new HIV infections in African countries are associated with herpes simplex virus type 2 (HSV-2). Thus, the magnitude of HSV-2 infection in an area may suggest the expected course of the HIV epidemic. We determined prevalence of genital herpes, syphilis and associated factors among pregnant women from a remote rural Tanzanian community that has a low but increasing HIV prevalence.


METHODS
We analysed 1296 sera and responses to a standard structured questionnaire collected from pregnant women aged between 15-49 years, attending six different antenatal clinics within rural Manyara and Singida regions in Tanzania. Linked anonymous testing (with informed consent) of the serum for specific antibodies against HSV-2 was done using a non-commercial peptide- 55 ELISA. Antibodies against syphilis were screened by using rapid plasma reagin (RPR) and reactive samples confirmed by Treponema pallidum haemagglutination assay (TPHA).


RESULTS
Previous analysis of the collected sera had shown the prevalence of HIV antibodies to be 2%. In the present study the prevalence of genital herpes and syphilis was 20.7% (95% CI: 18.53-23.00) and 1.6% (95% CI: 1.03-2.51), respectively. The presence of HSV-2 antibodies was associated with polygamy (OR 2.2, 95% CI: 1.62 - 3.01) and the use of contraceptives other than condoms (OR 1.7, 95% CI: 1.21 - 2.41). Syphilis was associated with reporting more than one lifetime sexual partner (OR 5.4, 95% CI: 1.88 - 15.76) and previous spontaneous abortion (OR 4.3, 95% CI: 1.52-12.02).


CONCLUSIONS
The low prevalence of HIV infection offers a unique opportunity for strengthening HIV prevention in a cost-effective manner. The identification and control of other prevalent curable STIs other than syphilis and specific intervention of HSV-2 in specific populations like pregnant women would be one among approaches towards preventing incident HIV infections.
Centre for International Health, University of Bergen, Bergen, Norway. khadija.malima@cih.uib.no
Khadija I
KI
Yahya-Malima
Bjørg
B
Evjen-Olsen
Mecky I
MI
Matee
Knut
K
Fylkesnes
Lars
L
Haarr
D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000302:isolation & purification; D000914:Antibodies, Viral / Q000302:isolation & purification; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D015497:HIV-1 / Q000302:isolation & purification; D006558:Herpes Genitalis / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D018258:Herpesvirus 2, Human / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology; D014210:Treponema pallidum / Q000276:immunology / Q000302:isolation & purification
D000907:Antibodies, Bacterial; D000914:Antibodies, Viral