Detection of sexually transmitted pathogens and co-infection with human papillomavirus in women residing in rural Eastern Cape, South Africa

Abstract

Background South African women of reproductive age have a high burden of sexually transmitted infections (STIs), including human papillomavirus (HPV) infection. However, there is limited information on the prevalence of sexually transmitted pathogens in women from rural Eastern Cape Province, South Africa. The study aims at determining the prevalence of sexually transmitted pathogens and co-infection with high-risk (HR) HPV among women from rural Eastern Cape Province, South Africa. Methods A total of 205 cervical specimens were collected from women aged ≥ 30 years from a rural community-based clinic. The samples were tested for a panel of pathogenic STIs [Chlamydia trachomatis (serovars A-K & L1-L3), Haemophilus ducreyi, Herpes Simplex Virus (Types 1 & 2), Neisseria gonorrhoeae, Treponema pallidum, Trichomonas vaginalis (TV), and pathobionts [Mycoplasma genitalium (MG), Mycoplasma hominis (MH) and Ureaplasma spp. (UP)] using a multiplex PCR STD direct flow chip assay through a manual Hybrispot platform (Master Diagnostica, Granada, Spain). HR-HPV detection was performed by Hybrid Capture-2 assay. Results High-risk HPV prevalence was 32.2% (66/205) and HIV-1 prevalence was 38.5% (79/205). The overall prevalence of six pathogenic STIs was 22.9% (47/205), with TV having the highest prevalence (15.6%; 32/205). UP (70.2%, 144/205) and MH (36.6%, 75/205) were the most frequently detected pathobionts. Co-infection with ≥ 2 pathogens pathobionts was observed among 52.7% (108/205) participants. Of the six pathogenic STIs, three participants had more than one STI (1.46%) with the presence of MH and UP. HSV-2 (OR: 4.17, CI [1.184–14.690]) and HIV infection (OR: 2.11, CI [1.145–3.873]) were independent STIs associated with HR-HPV infection. Conclusions The high prevalence of pathogenic STIs underscores the need to improve syndromic management policy by implementing effective strategies of prevention, screening tests, and management. HSV-2 and HIV positive remain strongly associated with HR-HPV infection.

Molecular Identification of Cervical Microbes in HIV-Negative and HIV-Positive Women in an African Setting Using a Customized Bacterial Vaginosis Microbial DNA Quantitative PCR (qPCR) Array

“…Since there is paucity of data on STI and pathobiont burden among South African women with and without HIV infection in rural Eastern Cape, we investigated the prevalences and risk factors of these microbes. The overall prevalence of both STIs and pathobionts in our present study is at least 2.5-fold higher than we previously reported using the STD direct flow chip assay ( 38 ), thus reflecting differences in sensitivity of the assays (including the cycle threshold [ C T ] cutoff value that we chose) and maybe sample selection. Compared to older HIV-negative women, younger HIV-negative women had a higher prevalence of STIs/pathobionts.…”

“…We noted that the prevalences of the individual STIs were low (each <5%) yet both consistent ( 38 ) and inconsistent ( 53 , 55 ) with previous reports on South African cohorts. This consistency is certainly because a large proportion of our present cohort was part of our previous study ( 38 ) of the STD direct flow chip assay. This low prevalence could be attributed to the fact that the women were older (perhaps with low-risk behaviors) and maybe receiving STI treatment.…”

“…Until now, the relationship of BV-associated bacteria and STIs with HIV remains poorly understood, with some authors finding no statistically significant associations between BV and individual STIs detected through Nugent scoring and quantitative PCR (qPCR), respectively ( 37 ). In a recent study ( 38 ), we employed a multiplex PCR-based STD direct flow chip assay to investigate the prevalence of 12 STIs and emerging sexually transmitted pathogens (pathobionts, commensal bacteria with pathogenic potential) among rural women (aged ≥30 years) with a high burden of HR-HPV (32.2%) and HIV-1 (38.5%) recruited from a rural community-based clinic in Eastern Cape (South Africa). These microbes included C. trachomatis (serovars L1 to L3 and serotypes A to K), herpes simplex virus (types I and II), T. vaginalis , N. gonorrhoeae , Treponema pallidum , Haemophilus ducreyi , Mycoplasma hominis , Mycoplasma genitalium , and ureaplasmas ( Ureaplasma urealyticum or Ureaplasma parvum ).…”

Genital Human Papillomavirus Prevalence and Genotyping Among Males in Putuo District of Shanghai, China 2015-2019

“…Human papillomavirus (HPV) is one of most common sexually transmitted viruses in men and women worldwide and can cause many types of dermatology problems and diseases, from benign warts to various cancers [ 1 , 2 ]. Several sexually transmitted infectious diseases, including HIV and HSV-2, are strongly correlated with HPV infection [ 3 ]. Chlamydia trachomatis infection contributes to the persistence of HPV and has been considered as a risk factor for cervical cancer [ 4 ].…”

Preferences for the management of sexually transmitted infections in the South African health system: A discrete choice experiment

“…The study included individuals who receive care from the fixed and mobile units of urban and peri-urban primary health care clinics in Tshwane sub-district in Gauteng Province and Nelson Mandela A in Eastern Cape Province of South Africa respectively using a combination of unassisted and research assistant-supported online surveys. In recent studies, the prevalence of any STI amongst pregnant women in the Tshwane sub-district was about 40% [15] and 22.9% amongst women attending a rural community clinic in the Eastern Cape [16]. The antenatal HIV prevalence in Tshwane districts and Nelson Mandela Bay were estimated at 28.7% and 29.7% % respectively [17].…”