Genital and Extragenital Sexually Transmitted Infections among Women of Reproductive Age in the Southern US Participating in the Study of Treatment and Reproductive outcomes (STAR)
Abstract Authors
Nicholas F. Nogueira, Paola Beato Fernandez, Yue Pan, Ana S. Salazar, Maria Gabriela Rodriguez, Gray Kelsey, Patricia Raccamarich, Laura Beauchamps, Daniel Westreich, Seble Kassaye, Elizabeth F. Topper, Aadia Rana, Deborah Konkle-Parker, Deborah L. Jones, Anandi N. Sheth, Maria L. Alcaide.
Author Affiliations
Mr. Nogueira: University of Miami, Miami, FL Ms. Beato Fernandez: University of Miami, Miami, FL Dr. Pan: University of Miami, Miami, FL Dr. Salazar: University of Miami, Miami, FL Ms. Rodriguez: University of Miami, Miami, FL Ms. Kelsey: University of Miami, Miami, FL Dr. Raccamarich: University of Miami, Miami, FL Dr. Beauchamps: University of Miami, Miami, FL Dr. Westreich: University of North Carolina, Chapel Hill, NC Dr. Kassaye: Georgetown University, Washington DC Dr. Topper: Johns Hopkins University, Baltimore, MD Dr. Rana: University of Alabama-Birmingham, Birmingham, AL Dr. Konkle-Parker: University of Mississippi Medical Center, Jackson, MS Dr. Jones: University of Miami, Miami, FL Dr. Sheth: Emory University, Atlanta, GA Dr. Alcaide: University of Miami, Miami, FL
Background
Sexually transmitted infections (STI) are highly prevalent among women of reproductive age (WRA) and increase risk of HIV acquisition and transmission. However, the burden of genital and extragenital STIs is understudied among WRA in the U.S.. Estimates of disease are urgently needed, including among women with and without HIV, to inform sex-specific screening guidelines.
Methods
Cross-sectional data from 519 cisgender women, 18-45 years-old enrolled in the STAR cohort from March 2021 to January 2023 at 6 Southern US sites were analyzed. Women living without HIV had at least one HIV risk factor in the previous 5 years. Socio-demographic and behavioral assessments were performed using structured interviewer-administered questionnaires. Nucleic-Acid Amplification Test (NAAT) was performed regardless of symptoms on self-collected urine, rectal, and pharyngeal swabs to detect chlamydia, gonorrhea, and trichomoniasis. Sociodemographic characteristics, risk factors, and incidence of STIs were tabulated and group comparisons by HIV status were examined.
Results
Mean age was 34.6 ± 6.95 years; 79.6% were Black, 15.5% White, and 11.4% Hispanic. Overall, 52.8% had never married, 45.7 % had a monthly income of $1500 or less, and 36.0% completed high school. Women had a median of 1 (IQR 1-2) male sexual partners in past year, 44.1% reported condomless vaginal sex in the past year, and 49% reported having ever had an STI: 35.2% reported a lifetime history of chlamydia, 26.0% gonorrhea, and 30.6% trichomoniasis. Current STI detected by NAAT did not differ by HIV status (22.0% HIV+ vs. 20.5% HIV-; p=0.946): vaginal chlamydia (2.1% HIV+ vs. 1.5% HIV-; p=0.915), rectal chlamydia (2.7% HIV+ vs. 3.1% HIV-; p=0.968), pharyngeal chlamydia (1.3% HIV+ vs. 0.0% HIV-; p=0.42), vaginal gonorrhea (3.8% HIV+ vs. 2.3% HIV-; p=0.727), rectal gonorrhea (0.9% HIV+ vs. 1.6% HIV-; p=0.843), pharyngeal gonorrhea (1.3% HIV+ vs. 0.8% HIV-; p=0.892), and trichomoniasis (14.3% HIV+ vs. 13.0% HIV-; p=0.937).
Conclusion(s)
Prevalence of genital and extragenital chlamydia and gonorrhea, and genital trichomoniasis are high among WRA with and without HIV infection. The implications for women's reproductive health and HIV transmission highlight the importance of extragenital STI testing for women with HIV or vulnerable to HIV infection.