Molecular epidemiology and socio-demographic risk factors of sexually transmitted infections among women in Lebanon

Abstract

Background Sexually transmitted infections (STIs) cause a major public health problem that affect both men and women in developing and developed countries. The aim of the study was to estimate the prevalence of 11 STIs among women who voluntarily participated in the study, while seeking gynecological checkup. The existence of an association between the presence of pathogens and symptoms and various sociodemographic risk factors was assessed. Methods A total of 505 vaginal and cervical specimens were collected from women above 18 years of age, with or without symptoms related to gynecological infections. Nucleic acid was extracted and samples were tested by real-time PCR for the following pathogens: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Ureaplasma urealyticum, Urealplasma parvum, Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma girerdii, Gardnerella vaginalis, Candida albicans and Human Papillomavirus (HPV). Positive HPV samples underwent genotyping using a microarray system. Results Of the 505 samples, 312 (62%) were screened positive for at least one pathogen. Of these, 36% were positive for Gardnerella vaginalis, 35% for Ureaplasma parvum, 8% for Candida albicans, 6.7% for HPV, 4.6% for Ureaplasma urealyticum, 3.6% for Mycoplasma hominis, 2% for Trichomonas vaginalis, 0.8% for Chlamydia trachomatis, 0.4% for Mycoplasma girerdii, 0.2% for Mycoplasma genitalium and 0.2% for Neisseria gonorrhoeae. Lack of symptoms was reported in 187 women (37%), among whom 61% were infected. Thirty-four samples were HPV positive, with 17 high risk HPV genotypes (HR-HPV); the highest rates being recorded for types 16 (38%), 18 (21%) and 51 (18%). Out of the 34 HPV positives, 29 participants had HR-HPV. Association with various risk factors were reported. Conclusions This is the first study that presents data about the presence of STIs among women in Lebanon and the MENA region by simultaneous detection of 11 pathogens. In the absence of systematic STI surveillance in Lebanon, concurrent screening for HPV and PAP smear is warranted.

Molecular epidemiology of human papillomavirus among HIV infected women in developing countries: systematic review and meta-analysis

“…The original research article conducted in Korea reported prevalence of 16.7% with the high risk HPV type of 12.5% [58] which is too far up when compared with the pooled estimates of the current review which focused on HIV positive women. In addition, the study among Arab women indicated 6.2% among Qatari women and 5.9% non-Qatari women [59] somewhat concordant with the study conducted in Lebanon which reported HPV prevalence of 6.7% [60]. This variation is probably attributed to the differences in the study settings, sample sizes used and the studied population.…”

Prevalence of STIs, sexual practices and substance use among 2083 sexually active unmarried women in Lebanon

“…Rates of HIV, Hepatitis and Syphilis were low; however, symptoms associated with a bacterial/parasitic STI (Neisseria Gonorrhea and/or Chlamydia Trachomatis, Ureaplasma Urealyticum/Parvum, Mycoplasma Genitalium, and Trichomonaisis) were relatively high among the subset that underwent medical consultations. In fact, symptoms indicative of gonorrhea/chlamydia were higher than the prevalence reported in a local study on a sample of 505 women 14 . It is important to note that the reported rates are most likely underreported since these infections can often be asymptomatic.…”

“…The prevalence of genital warts of 15% was also higher than the rate reported in the local study 14 . Even though this study reported prevalence of HPV based on the presence of genital warts (caused by non-cancerous strains of HPV) evidence attests to an increased risk of HPV-related cancer among those who have had genital warts 15 , 16 .…”

Sexually transmitted infections in pregnant women from sub-Saharan Africa

“…27 Most studies have reported that the rate of having multiple infections is much more common in younger women aged 16–19 years than in those aged above 35 years. 66 , 67 A study conducted in South Africa amongst pregnant women living with HIV reported the rate of coinfections to be 2.6% for C. trachomatis and N. gonorrhoeae , 8.6% for C. trachomatis and T. vaginalis , 0.7% for N. gonorrhoeae and T. vaginalis , and 1.4% had all three STIs. 22 Another study by Joseph et al 18 reported that in pregnant women living with HIV, 50% of those were coinfected when compared with 16% of women living without HIV who were coinfected ( p < 0.01).…”

“…Sexually transmitted infections have been reported to be associated with pelvic inflammatory disease (PID), adverse pregnancy outcomes, cervical cancer, infertility and multiple reproductive tract sequelae. 29 , 38 , 40 , 44 , 66 , 67 , 94 , 95 During pregnancy, untreated STIs may lead to a variety of complications including intrauterine death (spontaneous abortion), preterm delivery, intrauterine growth restriction, ectopic pregnancy, postpartum sepsis, congenital infection, stillbirth and low birth weight, miscarriage, neonatal conjunctivitis, neonatal pneumonia, premature rupture of membranes and chorioamnionitis. In men, subsequent subfertility may arise.…”