title: Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa.
abstract: OBJECTIVE
  It has been hypothesised that ectopy may be associated with increased susceptibility to sexually transmitted infections (STIs). In this cross-sectional study, we wanted to explore the association between STIs (including HIV) and cervical ectopy.
  
  
  METHODS
  We included 700 sexually active young women attending randomly selected high schools in a rural district in KwaZulu-Natal, South Africa. The district is endemic of HIV and has a high prevalence of STIs. We did computer-assisted measurements of the ectocervical area covered by columnar epithelium (ectopy) in colposcopic images and STI analyses on cervicovaginal lavage and serum samples. All participating women answered a questionnaire about sexual behaviour and use of contraceptives.
  
  
  RESULTS
  The mean age was 19.1 years. Ectopy was found in 27.2%, HIV in 27.8%, chlamydia in 25.3% and gonorrhoea in 15.6%. We found that age, parity, chlamydia and gonorrhoea, years since menarche, years since sexual debut and number of sexual partners were associated with ectopy. In multivariate analysis with chlamydia infection as the dependent variable, women with ectopy had increased odds of having chlamydia infection (adjusted OR 1.78, p=0.033). In women under 19 years of age, we found twofold higher odds of being HIV-positive for those with ectopy (OR 2.19, p=0.014).
  
  
  CONCLUSIONS
  In conclusion, cervical ectopy is associated with Chlamydia trachomatis infection and HIV in the youngest women.
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kleppa
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Sigve D
authors.initials: SD
authors.lastname: Holmen
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Kristine
authors.initials: K
authors.lastname: Lillebø
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway School of Public Health Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa.
authors.forename: Eyrun F
authors.identifier: http://orcid.org/0000-0002-5552-1095
authors.initials: EF
authors.lastname: Kjetland
authors.affiliation: Research Unit, Sorlandet Hospital, Kristiansand, Norway Department of Global Development and Planning, University of Agder, Kristiansand, Norway.
authors.forename: Svein Gunnar
authors.initials: SG
authors.lastname: Gundersen
authors.affiliation: School of Public Health Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa.
authors.forename: Myra
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Department of Infection Prevention and Control, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa.
authors.forename: Prashini
authors.initials: P
authors.lastname: Moodley
authors.affiliation: Department of Gynecology, OUH, Norway.
authors.forename: Mathias
authors.initials: M
authors.lastname: Onsrud
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D002690:Chlamydia Infections / Q000453:epidemiology*; D002692:Chlamydia trachomatis; D002828:Choristoma / Q000473:pathology*; D003430:Cross-Sectional Studies; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D012424:Rural Population; D012574:Schools; D013019:South Africa; D013334:Students; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: ADOLESCENT; AFRICA; CHLAMYDIA INFECTION; ECTOPY; HIV