Ginindza Themba G, Stefan Cristina D, Tsoka-Gwegweni Joyce M, Dlamini Xolisile, Jolly Pauline E, Weiderpass Elisabete, Broutet Nathalie, Sartorius Benn
Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Mazisi Kunene Road, 4041 Durban, South Africa.
Walter Sisulu University, Umtata, South Africa.
Infect Agent Cancer. 2017 May 25;12:29. doi: 10.1186/s13027-017-0140-y. eCollection 2017.
Sexually transmitted infections (STIs) remain an important public health problem with approximately half a billion new cases annually among persons aged 15-49 years. Epidemiological data on STIs among women of reproductive age in Swaziland are limited. The availability of epidemiological data on STIs and associated risk factors in this population is essential for the development of successful prevention, diagnosis and management strategies in the country. The study aimed to determine the prevalence and risk factors associated with STIs.
A total of 655 women aged 15-49 years were systematically enrolled from five health facilities using a cross-sectional study design. Cervical specimen were tested using GeneXpert CT/NG Assays for and , GeneXpertTV Assay for , and GeneXpert HPV Assays for hr-HPV. Blood samples were tested using Alere Determine HIV-1/2Ag/Ab Combo and Trinity Biotech Uni-Gold Recombigen HIV test for confirmation for HIV, and Rapid Plasma Reagin and TPHA test for confirmation for (syphilis). Genital warts were assessed prior to specimen collection. Survey weighted analyses were done to estimate the population burden of STIs.
The four most common curable STIs: CT, NG, TV, (syphilis), as well as genital warts were considered in this study. The overall weighted prevalence of any of these five STIs was 19.4% (95% CI: 14.9-24.8), corresponding to 72 990 women with STIs in Swaziland. The estimated prevalences were 7.0% (95% CI: 4.1-11.2) for CT, 6.0% (95% CI: 3.8-8.8) for NG, 8.4% (95% CI: 5.4-12.8) for TV, 1.4% (95% CI: 1.1-10.2) for syphilis and 2.0% (95% CI: 1.0-11.4) for genital warts. The overall weighted HIV prevalence was 42.7% (95%CI: 35.7-46.2). Among hr-HPV positive women, 18.8% (95% CI: 13.1-26.3) had one STI, while 6.3% (95% CI: 3.3-11.7) had multiple STIs. Risk factors associated with STIs were being employed (OR = 2.2, 95% CI: 1.0-4.7), self-employed (OR = 2.8, 95% CI: 1.5-5.5) and being hr-HPV positive (OR = 2.0, 95% CI: 1.3-3.1). Age (0.9, 95% CI: 0.8-0.9), being married (OR = 0.4, 95% CI: 0.3-0.7) and not using condoms with regular partners (OR = 0.5, 95% CI: 0.3-0.9) were inversely associated with STIs.
STIs are highly prevalent among women of reproductive age in Swaziland. Thus, a comprehensive STIs screening, surveillance and treatment programme would be justified and could potentially lower the burden of STIs in the country.
性传播感染（STIs）仍然是一个重要的公共卫生问题，在15 - 49岁人群中，每年新增病例约达5亿例。斯威士兰育龄妇女中性传播感染的流行病学数据有限。该人群中性传播感染及其相关风险因素的流行病学数据对于该国制定成功的预防、诊断和管理策略至关重要。本研究旨在确定性传播感染的患病率及其相关风险因素。
采用横断面研究设计，从五个卫生机构系统招募了655名年龄在15 - 49岁之间的女性。宫颈标本采用GeneXpert CT/NG检测法检测沙眼衣原体（CT）和淋病奈瑟菌（NG），采用GeneXpert TV检测法检测阴道毛滴虫（TV），采用GeneXpert HPV检测法检测高危型人乳头瘤病毒（hr-HPV）。血液样本采用Alere Determine HIV-1/2Ag/Ab Combo检测法和Trinity Biotech Uni-Gold Recombigen HIV检测法进行HIV确认检测，采用快速血浆反应素试验和梅毒螺旋体血凝试验进行梅毒确认检测。在采集标本前对尖锐湿疣进行评估。采用调查加权分析来估计性传播感染的人群负担。
本研究考虑了四种最常见的可治愈性传播感染：CT、NG、TV、梅毒，以及尖锐湿疣。这五种性传播感染中任何一种的总体加权患病率为19.4%（95%置信区间：14.9 - 24.8），相当于斯威士兰有72990名患有性传播感染的女性。估计患病率分别为：CT为7.0%（95%置信区间：4.1 - 11.2），NG为6.0%（95%置信区间：3.8 - 8.8），TV为8.4%（95%置信区间：5.4 - 12.8），梅毒为1.4%（95%置信区间：1.1 - 10.2），尖锐湿疣为2.0%（95%置信区间：1.0 - 11.4）。总体加权HIV患病率为42.7%（95%置信区间：35.7 - 46.2）。在hr-HPV阳性女性中，18.8%（95%置信区间：13.1 - 26.3）患有一种性传播感染，而6.3%（95%置信区间：3.3 - 11.7）患有多种性传播感染。与性传播感染相关的风险因素包括就业（比值比[OR]=2.2，95%置信区间：1.0 - 4.7）、自营职业（OR = 2.8，95%置信区间：1.5 - 5.5）以及hr-HPV阳性（OR = 2.0，95%置信区间：1.3 - 3.1）。年龄（0.9，95%置信区间：0.8 - 0.9）、已婚（OR = 0.4，95%置信区间：0.3 - 0.7）以及与固定性伴侣不使用避孕套（OR = 0.5，95%置信区间：0.3 - 0.9）与性传播感染呈负相关。
性传播感染在斯威士兰育龄妇女中高度流行。因此，开展全面的性传播感染筛查、监测和治疗项目是合理且必要的，这有可能降低该国性传播感染的负担。
