From the Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL.
Sex Transm Dis. 2024 Jun 1;51(6):431-436. doi: 10.1097/OLQ.0000000000001951. Epub 2024 Feb 19.
Integrating sexually transmitted infection (STI) and preexposure prophylaxis (PrEP) care may optimize sexual and reproductive health.
We nested an STI substudy within a human immunodeficiency virus (HIV) prevention cohort (parent study) of 18- to 35-year-old women from South Africa, planning pregnancy with a partner with HIV or of unknown serostatus. Parent-study women completed annual surveys regarding HIV-risk perceptions and were offered oral PrEP. Preexposure prophylaxis initiators completed quarterly plasma tenofovir (TFV) testing. Substudy women completed STI screening at enrollment, 6 months, onset of pregnancy, and in the third trimester via examination, vaginal swabs tested via PCR for Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis , Mycoplasma genitalium , and blood tested for Treponema pallidum . Follow-up was 6 months. Women with STIs were treated, offered partner notification (PN) cards, and surveyed regarding PN practices. We describe STI prevalence and incidence, and model factors associated with prevalent infection. Sexually transmitted infection substudy and parent study-only participants were matched on age and number of days on study to assess HIV-risk perception scores between the 2 groups and the proportion with detectable TFV.
Among 50 substudy participants, 15 (30%) had prevalent STI. All 13 completing follow-up reported PN. Most did not prefer assisted PN. Mean HIV risk perception scores and proportion with detected plasma TFV were similar across groups.
High STI prevalence supports the importance of laboratory screening to optimize sexual health for women planning pregnancy. Rates of self-reported PN are reassuring; low interest in assisted PN suggests the need for alternative approaches. Enhanced STI care did not affect HIV-risk perception or PrEP adherence, however both were relatively high in this cohort.
将性传播感染（STI）和暴露前预防（PrEP）护理相结合，可能会优化性和生殖健康。
我们在南非 18 至 35 岁的、与携带 HIV 或 HIV 血清状态未知的伴侣计划妊娠的妇女的 HIV 预防队列（母研究）中嵌套了一个 STI 子研究，该队列中的妇女每年完成有关 HIV 风险认知的调查，并提供口服 PrEP。PrEP 启动者每季度进行一次血浆替诺福韦（TFV）检测。子研究中的女性在入组时、6 个月、妊娠开始时以及第三个孕期通过检查进行 STI 筛查，通过 PCR 检测阴道拭子中的沙眼衣原体、淋病奈瑟菌、阴道毛滴虫、生殖支原体和血液中的梅毒螺旋体。随访时间为 6 个月。患有 STI 的女性接受治疗，获得伴侣通知（PN）卡，并就 PN 实践进行调查。我们描述了 STI 的流行率和发病率，并对与现患感染相关的因素进行建模。性传播感染子研究和仅参加母研究的参与者按年龄和研究天数进行匹配，以评估这两组之间的 HIV 风险认知评分和可检测到 TFV 的比例。
在 50 名子研究参与者中，有 15 名（30%）患有现患性 STI。所有完成随访的 13 名女性都报告了 PN。大多数人不喜欢辅助 PN。两组之间的平均 HIV 风险认知评分和可检测到血浆 TFV 的比例相似。
高 STI 流行率支持对计划妊娠的妇女进行实验室筛查以优化性健康的重要性。自我报告的 PN 率令人放心；对辅助 PN 的兴趣较低表明需要替代方法。然而，在这个队列中，两者的比例都相对较高，增强的 STI 护理并未影响 HIV 风险认知或 PrEP 依从性。
