Sociodemographic factors and STIs associated with Chlamydia trachomatis and Neisseria gonorrhoeae infections in Zambian female sex workers and single mothers

• Type of Material: Article
• Authors: Sarah Connolly, Emory University; Kristin Wall, Emory University; Rachel Parker, Emory University; William Kilembe, Zambia Emory HIV Res Project; Mubiana Inambao, Zambia Emory HIV Res Project; Ana-Maria Visoiu, Zambia Emory HIV Res Project; Tyronza Sharkey, Zambia Emory HIV Res Project; Eric Hunter, Emory University; Susan Allen, Emory University
• Language: English
• Date: 2020-03-01
• Publisher: SAGE Publications Ltd.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 by SAGE Publications.
• Final Published Version (URL): http://dx.doi.org/10.1177/0956462419894453
• Title of Journal or Parent Work: International Journal of STD & AIDS
• Volume: 31
• Issue: 4
• Start Page: 364
• End Page: 374
• Grant/Funding Information: This work was supported by the National Institute of Child Health and Development [NICHD R01, HD40125];; National Institute of Allergy and Infectious Diseases [NIAID R01 AI51231, NIAID R01 AI040951, NIAID R01 AI023980, NIAID R01 AI64060, NIAID R37 AI51231)].; National Institute of Mental Health [NIMH R01 66767]; the AIDS International Training and Research Program Fogarty International Center [D43 TW001042];; This study was supported by the International AIDS Vaccine Initiative (IAVI), the United States Agency for International Development (USAID), the Emory Center for AIDS Research, the Burroughs Wellcome Fund, and the Emory Global Health Institute.
• Keywords: Risk; HIV-Discordant couples; Cells; Women; Life Sciences & Biomedicine; Chlamydia; Africa; Immunology; women; Science & Technology; Immunity; gonorrhea; epidemiology; Infectious Diseases
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Immunology; Biology, Cell; Health Sciences, Pathology

Abstract

Sexually transmitted infections (STIs) in women caused by Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG) are epidemiologically distinct. In this study, associations with sociodemographic and clinical risk factors are explored separately for CT and NG. Multivariate logistic regression (MLR) models quantify associations between potential CT and/or NG risk factors within a cross-sectional study of high-risk women in two Zambian cities, Lusaka and Ndola. CT was associated with living in Lusaka, younger age, and literacy. Long-acting reversible contraception (LARC) was predictive of CT in Ndola, but protective in Lusaka. In Lusaka only, CT was associated with lower education and reported unprotected sex. NG was associated with younger age, lower education, concurrent Trichomonas vaginalis, bacterial vaginosis, and incident syphilis infection. Signs and symptoms were rare and not associated with either infection. CT was more prevalent, nearly 11%, compared to NG, 6.8%. The higher prevalence of CT could explain the lack of association with other STIs. The associations observed with NG could be the result of high-risk sexual networks or lack of protective immunity. Risk factors for CT and NG are distinct and may differ geographically, which should be considered when developing diagnostic tools or guiding presumptive treatment in specific populations.