title: African women recently infected with HIV-1 and HSV-2 have increased risk of acquiring Neisseria gonorrhoeae and Chlamydia trachomatis in the Methods for Improving Reproductive Health in Africa trial.
abstract: BACKGROUND
  Neisseria gonorrhoeae and Chlamydia trachomatis are 2 common causative agents of cervical bacterial sexually transmitted infections (STI). Against the background of the concurrent epidemics of STIs and HIV in sub-Saharan Africa, we examined the effect of HIV-1 and HSV-2 on acquiring N. gonorrhoeae and C. trachomatis in a cohort of southern African women at risk for HIV infection.
  
  
  METHODS
  We examined incidence of first infection with N. gonorrhoeae and C. trachomatis in the multisite randomized controlled trial Methods for Improving Reproductive Health in Africa. Multivariable Cox proportional hazards models with time-dependent covariates were used.
  
  
  RESULTS
  The incidence rates of C. trachomatis and N. gonorrhoeae infections were 6.14 per 100 woman-years and 2.42 per 100 women-years, respectively. In multivariable analyses, women who became infected with HIV-1 were more likely to acquire C. trachomatis (adjusted hazard ratio [adj. HR], 1.86; 95% confidence interval [CI], 1.34-2.57) and N. gonorrhoeae (adj. HR, 2.29; 95% CI, 1.47-3.56) compared with HIV-uninfected women. Similarly, HSV-2 infected women were more likely to acquire C. trachomatis (adj. HR, 1.29; 95% CI, 1.05-1.58) and N. gonorrhoeae (adj. HR, 1.57; 95% CI, 1.11-2.21). Women who were of younger age, who did not live with their primary male partner, and who changed sex partners during the study were also more likely to acquire a cervical STI.
  
  
  CONCLUSIONS
  Women recently infected with HIV-1 and HSV-2 were at increased risk of acquiring N. gonorrhoeae and C. trachomatis. Proactive screening and treatment of these common cervical infections, particularly among those infected with HIV-1 and HSV-2, should be considered for young sexually active women in settings with a high prevalence of HIV/STIs.
authors.affiliation: Department of Community Health, Alpert Medical School, Brown University, Providence, RI, USA. kartik_venkatesh@brown.edu
authors.forename: Kartik K
authors.initials: KK
authors.lastname: Venkatesh
authors.forename: Ariane
authors.initials: A
authors.lastname: van der Straten
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Kelly
authors.initials: K
authors.lastname: Blanchard
authors.forename: Gita
authors.initials: G
authors.lastname: Ramjee
authors.forename: Mark N
authors.initials: MN
authors.lastname: Lurie
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Padian
authors.forename: Guy
authors.initials: G
authors.lastname: de Bruyn
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D002692:Chlamydia trachomatis; D015331:Cohort Studies; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data; D005260:Female; D005782:Gels / Q000008:administration & dosage; D006069:Gonorrhea / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D015497:HIV-1; D006558:Herpes Genitalis / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D018258:Herpesvirus 2, Human; D006801:Humans; D008875:Middle Aged; D009344:Neisseria gonorrhoeae; D015995:Prevalence; D060728:Reproductive Health; D012307:Risk Factors; D015231:Sexually Transmitted Diseases, Bacterial / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D005782:Gels