Kerschberger Bernhard, Ntshalintshali Nombuso, Mafomisa Mano Isaac, Mabhena Edwin, Daka Michelle, Mukooza Esther, Lekelem Skinner, Dlamini Sindisiwe, Mavimbela Mpumelelo, Dube Lenhle, Matse Sindy, Mabuza Nomvuyo, de Latour Roberto, Trellu Laurence Toutous, Karakozian Hayk, Staderini Nelly, Haile Melat, Valladares Pablo, Calmy Alexandra, Ciglenecki Iza
Médecins Sans Frontières (MSF), Mbabane, Eswatini.
National Reference Laboratory (NRL), Ministry of Health, Mbabane, Eswatini.
Trop Med Int Health. 2025 Sep;30(9):987-1005. doi: 10.1111/tmi.70011. Epub 2025 Jul 22.
Sexually transmitted infections are a global public health concern. We aimed to assess the burden of a diverse range of sexually transmitted infections in a high HIV burden setting in Eswatini and associated risk factors.
This cross-sectional study enrolled adults accessing routine outpatient care at six sites in Shiselweni, from July 2022 to April 2023. Laboratory investigations included antibody-based tests for HIV, Treponema pallidum , hepatitis B, hepatitis C, and herpes simplex 2 viruses. The molecular-based Xpert platform tested urine samples for Chlamydia trachomatis , Neisseria gonorrhoea, Trichomonas vaginalis, self-collected vaginal/anal swabs for Human papillomavirus, and plasma for HIV viremia. We calculated the proportion of laboratory-confirmed sexually transmitted infections among available test results and identified predictors of combined Chlamydia trachomatis /Neisseria gonorrhoea/Trichomonas vaginalis infection.
Of 1396 study participants, 65.4% were women, the median age was 29 (IQR 23-36) years, and 19.6% were known HIV-positive. Overall, 68.6% had symptoms suggestive of Chlamydia trachomatis /Neisseria gonorrhoea/Trichomonas vaginalis infections. Laboratory-confirmed Chlamydia trachomatis /Neisseria gonorrhoea/Trichomonas vaginalis infection was found in 31.7% (n = 443/1396), of whom 20.8% were asymptomatic. Combined Chlamydia trachomatis /Neisseria gonorrhoea/Trichomonas vaginalis infections were common even among individuals with low risk of infection (e.g., no sexual intercourse: 20.7%) and were associated with young age, factory employment, and transactional sex. Prevalences for individual sexually transmitted infections were 16.9% (n = 236/1394) for Chlamydia trachomatis , 12.4% (n = 173/1394) for Neisseria gonorrhoea, 10.6% (n = 148/1390) for Trichomonas vaginalis, and 9.7% (n = 135) for Treponema pallidum . Viral infections were high for herpes simplex 2 viruses (n = 792/1279, 61.9%) and human papillomavirus (n = 166/324, 51.2%) and lower for hepatitis B virus (n = 55/1396, 3.9%) and hepatitis C virus (n = 3/1396, 0.2%). Of 1122 clients undergoing HIV testing, 4.1% (n = 46/1122) tested positive, with 21.7% (n = 10/46) being acute/early HIV infection.
The substantial sexually transmitted infections burden highlights the urgent need to strengthen sexually transmitted infections service integration, expand access to affordable diagnostics, and target prevention in decentralised care. These findings support the development of context-adapted strategies to improve detection, treatment, and partner services in high-burden settings.
性传播感染是一个全球公共卫生问题。我们旨在评估斯威士兰艾滋病毒高负担地区多种性传播感染的负担及相关危险因素。
这项横断面研究纳入了2022年7月至2023年4月期间在希塞尔韦尼六个地点接受常规门诊护理的成年人。实验室检查包括针对艾滋病毒、梅毒螺旋体、乙型肝炎、丙型肝炎和单纯疱疹2型病毒的基于抗体的检测。基于分子的Xpert平台检测尿样中的沙眼衣原体、淋病奈瑟菌、阴道毛滴虫，自我采集的阴道/肛门拭子检测人乳头瘤病毒，血浆检测艾滋病毒血症。我们计算了可用检测结果中实验室确诊的性传播感染比例，并确定了沙眼衣原体/淋病奈瑟菌/阴道毛滴虫合并感染的预测因素。
在1396名研究参与者中，65.4%为女性，中位年龄为29岁（四分位间距23 - 36岁），19.6%为已知艾滋病毒阳性。总体而言，68.6%的人有提示沙眼衣原体/淋病奈瑟菌/阴道毛滴虫感染的症状。实验室确诊的沙眼衣原体/淋病奈瑟菌/阴道毛滴虫感染率为31.7%（n = 443/1396），其中20.8%无症状。沙眼衣原体/淋病奈瑟菌/阴道毛滴虫合并感染在感染风险低的个体中也很常见（例如，无性交：20.7%），并与年轻、工厂就业和交易性行为有关。个别性传播感染的患病率分别为：沙眼衣原体16.9%（n = 236/1394），淋病奈瑟菌12.4%（n = 173/1394），阴道毛滴虫10.6%（n = 148/1390），梅毒螺旋体9.7%（n = 135）。单纯疱疹2型病毒（n = 792/1279，61.9%）和人乳头瘤病毒（n = 166/324，51.2%）的病毒感染率较高，而乙型肝炎病毒（n = 55/1396，3.9%）和丙型肝炎病毒（n = 3/
