title: Sexual violence, HSV-2 and HIV are important predictors for infertility in Rwanda.
abstract: BACKGROUND
  In order to formulate cost-effective health interventions aimed at preventing infertility it is necessary to identify modifiable risk factors for infertility in sub-Saharan Africa. This case-control study examined potential predictors and their population attributable fraction (PAF%) for various infertility types including lifestyle factors, sexual behaviour and reproductive tract infections (RTIs).
  
  
  METHODS
  Sexually active women aged 21-45 year presenting with infertility problems at the infertility clinic of the Kigali University Teaching Hospital (n = 312), and fertile controls who recently delivered (n = 283) were surveyed together with their male partners. Participants were interviewed about socio-demographic characteristics, sexual behaviours and lifestyle factors, and were tested for HIV and RTIs.
  
  
  RESULTS
  Variables significantly associated with tubal infertility were history of sexual violence [adjusted odds ratio (AOR) 2.41; 95% CI 1.36-4.25]; positive HIV (AOR 2.41; 95% CI 1.36-4.25), herpes simplex virus type 2 (HSV-2; AOR 1.67; 95% CI 1.03-2.71) and Chlamydia trachomatis serology (AOR 1.78; 95% CI 0.99-3.21), and current bacterial vaginosis by Amsel criteria (AOR 1.97; 95% CI 1.12-3.47). Among men, male factor infertility was associated with positive HIV (AOR 2.43; 95% CI 1.31-5.23) and HSV-2 serology (AOR 1.71; 95% CI 1.02-2.87) and current urologic abnormalities (AOR 2.38; 95% CI 1.01-5.31). Positive HSV-2 serostatus carried the greatest PAF% (26%) for tubal infertility, followed by positive HIV serostatus (20%) and history of sexual violence (17%).
  
  
  CONCLUSIONS
  Although temporal relationships are difficult to ascertain, history of sexual violence, HSV-2 infection and HIV infection are important predictors of infertility in Rwanda.
authors.affiliation: International Centre for Reproductive Health, Ghent University, Ghent, Belgium. dhontnathalie@gmail.com
authors.forename: N
authors.initials: N
authors.lastname: Dhont
authors.forename: J
authors.initials: J
authors.lastname: van de Wijgert
authors.forename: S
authors.initials: S
authors.lastname: Luchters
authors.forename: C
authors.initials: C
authors.lastname: Muvunyi
authors.forename: J
authors.initials: J
authors.lastname: Vyankandondera
authors.forename: M
authors.initials: M
authors.lastname: Temmerman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002690:Chlamydia Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology* / Q000635:transmission; D006558:Herpes Genitalis / Q000097:blood / Q000453:epidemiology* / Q000635:transmission; D018258:Herpesvirus 2, Human; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000453:epidemiology* / Q000821:virology; D007248:Infertility, Male / Q000097:blood / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012432:Rwanda / Q000453:epidemiology; D012742:Sex Offenses; D012725:Sexual Behavior / Q000706:statistics & numerical data; D014627:Vaginitis / Q000453:epidemiology / Q000821:virology; D014754:Violence; D055815:Young Adult