Background The ideal vaginal microbicide should reduce the risk of HIV infection and other reproductive tract infections (RTIs) while preserving the integrity of the cervicovaginal epithelium. Future microbicides and multipurpose prevention technologies (MPT) could improve maternal reproductive health and prevent multiple sexually transmitted infections.

Objectives and Methods The Microbicide Safety Biomarkers Study is a prospective cohort study of 110 adults, 30 adolescents and 30 pregnant women in Kenya and South-Africa, 30 women engaging in vaginal practises in South-Africa and 30 high-risk and 30 HIV-positive women in Rwanda. RTIs and biomarkers of the vaginal microbiome and inflammation were studied.

Results Baseline prevalence RTI data are presented in the table. A significant difference (p = 0.027 to 0.001) between the study groups was present for all RTIs except for Trichomonas vaginalis (TV). Neisseria gonorrhoeae (NG), syphilis and HSV-2 were associated (p = < 0.001) with sexual risk taking behaviour (sex worker OR at least 3 partners last year OR at least one sexual partner with HIV in the past 3 months OR age first sex less than 15 years). HSV-2 was detected in 51.5% of the high risk-takers compared to 28.6% of the low risk-takers. For women with bacterial vaginosis (Nugent 7–10) Chlamydia trachomatis (CT) (p = < 0.028) was present in 14.9% and TV (p = < 0.001) in 9% compared to 6.3% and 1.5% in women without BV (Nugent 0–3), respectively.

Conclusion RTIs are common among African women targeted for microbicide trials. The introduction of a MPT targeting a combined prevention of HIV and HSV-2 is warranted in these populations.