title: High prevalence and incidence of sexually transmitted infections among women living in Kwazulu-Natal, South Africa.
abstract: OBJECTIVE
  Sexually transmitted infections (STIs) contribute largely to the burden of health in South Africa and are recognized as major contributors to the human immunodeficiency virus (HIV) epidemic. Young women are particularly vulnerable to STIs. The purpose of this secondary analysis was to examine the risk factors associated with prevalent and incident STIs among women who had participated in three clinical trials.
  
  
  METHODS
  A total of 5,748 women were screened and 2293 sexually active, HIV negative, non-pregnant women were enrolled in three clinical trials in Kwazulu-Natal, South Africa. The prevalence of individual STIs Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), syphilis, and Trichomonas vaginalis (TV) was assessed at screening; and incident infections were evaluated over a 24 month period.
  
  
  RESULTS
  Overall, the combined study population of all three trials had a median age of 28 years (inter-quartile range (IQR):22-37), and a median duration of follow-up of 12 months. Prevalence of STIs (CT, NG, TV, or syphilis) was 13% at screening. The STI incidence was estimated to be 20/100 women years. Younger women (<25 years, p < 0.001), women who were unmarried (p < 0.001) and non-cohabiting women (p < 0.001) were shown to be at highest risk for incident STIs.
  
  
  CONCLUSIONS
  These results confirm the extremely high prevalence and incidence of STIs among women living in rural and urban communities of KwaZulu-Natal, South Africa, where the HIV epidemic is also particularly severe. These findings strongly suggest an urgent need to allocate resources for STI and HIV prevention that mainly target younger women.
  
  
  BACKGROUND
  Clinical Trials.gov, NCT00121459.
authors.affiliation: HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa.
authors.forename: Sarita
authors.initials: S
authors.lastname: Naidoo
authors.affiliation: National Center for HIV Epidemiology and Clinical Research, Sydney, Australia.
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.affiliation: HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa.
authors.forename: Nathlee Samantha
authors.initials: NS
authors.lastname: Abbai
authors.affiliation: HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa ; Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Gita
authors.initials: G
authors.lastname: Ramjee
keywords: HIV; Incidence; Kwa-Zulu Natal; Prevalence; Risk factors; Sexually transmitted infections; Women