Nogueira Nicholas F, Beauchamps Laura S, Pan Yue, Beato Fernandez Paola, Rodriguez Maria Gabriela, Kelsey Gray, Raccamarich Patricia, Sternberg Candice A, Westreich Daniel, Kassaye Seble G, Topper Elizabeth F, Rana Aadia, Konkle-Parker Deborah, Jones Deborah L, Sheth Anandi N, Alcaide Maria L
Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States.
Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States.
Front Med (Lausanne). 2025 Mar 26;12:1537427. doi: 10.3389/fmed.2025.1537427. eCollection 2025.
Sexually transmitted infections (STI) are highly prevalent among women of reproductive age (WRA) and increase the risk of HIV acquisition and transmission. However, the burden of extragenital STIs is understudied among WRA in the US. Estimates of disease are urgently needed among women living with (WWH) and without HIV (WWOH), to inform sex-specific screening guidelines.
Cross-sectional data from cisgender WWH and WWOH, ages 18-45 years, enrolled in the Study of Treatment and Reproductive Outcomes (STAR) from March 2021 to August 2023 at six Southern US sites was analyzed. Sociodemographic and behavioral assessments were performed using structured interviewer-administered questionnaires. Nucleic-acid amplification tests were performed, regardless of symptoms, on self-collected urine, rectal, and pharyngeal swabs to detect trichomoniasis, chlamydia, and gonorrhea. Sociodemographic characteristics and risk factors were compared by STI status and concordance between genital and extragenital STIs was examined.
Among the 543 participants, 55.2% WWH, mean age was 34.0 (SD ± 7.14) years old, most (72.5%) were non-Hispanic Black, 41.6% had multiple sexual partners, and 85.6% engaged in unprotected sex. Overall, 1.9% tested positive for genital chlamydia, 2.9% rectal chlamydia, 0.6% oropharyngeal chlamydia, 3.4% genital gonorrhea, 1.2% rectal gonorrhea, 1.3% oropharyngeal gonorrhea, and 12.2% trichomoniasis. Genital chlamydia was associated with rectal chlamydia ( < 0.001) but not oropharyngeal chlamydia; and genital gonorrhea associated with rectal ( < 0.001) and oropharyngeal ( = 0.0011) gonorrhea. Eight (11.1%) pregnant participants were diagnosed with at least one STI. Higher genital chlamydia risk was associated with women without healthcare provider visits in the past year [RR = 7.14, 95% CI (1.92, 25.00); = 0.043]; while higher trichomoniasis risk was associated with lower educational attainment of high school or below [RR = 2.94, 95% CI (1.49, 5.88); = 0.009] and an average monthly income of less than $1,500 USD [RR = 4.76, 95% CI (1.82, 12.5); = 0.011]. HIV-status was not associated with genital or extragenital STIs.
Prevalence of genital, rectal, oral chlamydia (1.8%, 2.8%, and 0.6%) and gonorrhea (3.3%, 1.1%, and 1.3%), and genital trichomoniasis (11.4%) are high among WRA with and without HIV. The adverse impact for women's reproductive health and HIV transmission highlights the importance of extragenital STI testing for women in areas of high prevalence of STIs in the US.
性传播感染（STI）在育龄妇女（WRA）中高度流行，并增加了感染和传播艾滋病毒的风险。然而，美国育龄妇女中生殖器外性传播感染的负担尚未得到充分研究。迫切需要了解感染艾滋病毒的妇女（WWH）和未感染艾滋病毒的妇女（WWOH）的疾病估计情况，以为针对性别的筛查指南提供依据。
分析了2021年3月至2023年8月期间在美国南部六个地点参加治疗与生殖结果研究（STAR）的18至45岁顺性别感染艾滋病毒的妇女和未感染艾滋病毒的妇女的横断面数据。使用结构化访谈问卷进行社会人口学和行为评估。无论有无症状，均对自行采集的尿液、直肠和咽拭子进行核酸扩增检测，以检测滴虫、衣原体和淋病。按性传播感染状况比较社会人口学特征和危险因素，并检查生殖器和生殖器外性传播感染之间的一致性。
在543名参与者中，55.2%为感染艾滋病毒的妇女，平均年龄为34.0（标准差±7.14）岁，大多数（72.5%）为非西班牙裔黑人，41.6%有多个性伴侣，85.6%有未采取保护措施的性行为。总体而言，1.9%的人生殖器衣原体检测呈阳性，2.9%的人直肠衣原体检测呈阳性，0.6%的人咽衣原体检测呈阳性，3.4%的人生殖器淋病检测呈阳性，1.2%的人直肠淋病检测呈阳性，1.3%的人咽淋病检测呈阳性，12.2%的人滴虫检测呈阳性。生殖器衣原体与直肠衣原体相关（<0.001），但与咽衣原体无关；生殖器淋病与直肠淋病（<0.001）和咽淋病（=0.0011）相关。八名（11.1%）怀孕参与者被诊断出至少患有一种性传播感染。过去一年未就医的女性患生殖器衣原体的风险较高[相对风险=7.14，95%置信区间（1.92，25.00）；P=0.043]；而患滴虫病风险较高与高中及以下学历[相对风险=2.94，95%置信区间（1.49，5.88）；P=0.009]以及月平均收入低于1500美元有关[相对风险=4.76，95%置信区间（1.
