Population-level data on sexually transmitted infections (STIs) are rare in sub-Saharan Africa. We measured the prevalence of HIV and five STIs following the roll-out of voluntary medical male circumcision and universal HIV treatment programs in an HIV hyperendemic Lake Victoria fishing community in Uganda.
We measured prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), syphilis, and herpes simplex virus type 2 (HSV-2) among all consenting adults aged 15-49 participating in the Rakai Community Cohort Study between May and July 2019. CT and NG testing was conducted using nucleic acid amplification testing (Abbott RealTime CT/NG assay). Point-of-care testing was done for TV (OSOM Trichomonas) and syphilis (non-treponemal SDBioline rapid syphilis tests), with subsequent laboratory confirmation of syphilis titers using a rapid plasma regain (RPR) test (Cypress Diagnostics). Participants were classified as having active syphilis infection if their RPR titers were ≥1:8. HSV-2 testing was performed with the Kalon HSV-2 IgG ELISA. Associations of STIs with ART use and male circumcision were estimated using Poisson regression.
There were 898 participants, including 435 women (48%), of whom 9% (n=47) were pregnant. There were 398 (40%) who were HIV seropositive. Coverage of ART was 78% (n=301) among HIV seropositive persons and 57% of men (n=264) were circumcised. Overall, there was 8.5% prevalence of NG (n=76), 9.9% CT (n=88), and 12% TV (n=108) (Figure). Syphilis reactivity was 24% (n=216), with 9.4% (n=85) of the total population having titers indicative of active syphilis infection, including 6% of pregnant women (n=3). HSV-2 antibodies were detected in 70% of the population (n=626), including 94% of HIV-positive persons. While prevalence of at least one STI (NG, TV, CT, or active syphilis) was 1.57 fold higher among HIV-positive versus HIV negative persons (34 vs 21% ; 95%CI: 1.20-2.05), there was no differences in STI prevalence by ART status (Prevalence risk ratio [PRR]=0.95; 95%CI: 0.55-1.78) or male circumcision status among all men (PRR=0.93; 95%CI: 0.62-1.38).
Despite high coverage of HIV treatment and prevention interventions, the burden of STIs remains extremely high in Lake Victoria fishing communities. There is an urgent need to integrate STI diagnostic testing and treatment with HIV services in these high HIV burdened settings.