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Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa
  1. Elisabeth Kleppa1,2,
  2. Sigve D Holmen1,2,
  3. Kristine Lillebø1,2,
  4. Eyrun F Kjetland1,3,
  5. Svein Gunnar Gundersen4,5,
  6. Myra Taylor3,
  7. Prashini Moodley6,
  8. Mathias Onsrud7
  1. 1Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
  2. 2Faculty of Medicine, University of Oslo, Oslo, Norway
  3. 3School of Public Health Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa
  4. 4Research Unit, Sorlandet Hospital, Kristiansand, Norway
  5. 5Department of Global Development and Planning, University of Agder, Kristiansand, Norway
  6. 6Department of Infection Prevention and Control, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa
  7. 7Department of Gynecology, OUH, Norway
  1. Correspondence to Dr Elisabeth Kleppa, Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Postboks 4956 Nydalen, Oslo 0424, Norway; elisabeth.kleppa{at}


Objectives It has been hypothesised that ectopy may be associated with increased susceptibility to sexually transmitted infections (STIs). In this cross-sectional study, we wanted to explore the association between STIs (including HIV) and cervical ectopy.

Methods We included 700 sexually active young women attending randomly selected high schools in a rural district in KwaZulu-Natal, South Africa. The district is endemic of HIV and has a high prevalence of STIs. We did computer-assisted measurements of the ectocervical area covered by columnar epithelium (ectopy) in colposcopic images and STI analyses on cervicovaginal lavage and serum samples. All participating women answered a questionnaire about sexual behaviour and use of contraceptives.

Results The mean age was 19.1 years. Ectopy was found in 27.2%, HIV in 27.8%, chlamydia in 25.3% and gonorrhoea in 15.6%. We found that age, parity, chlamydia and gonorrhoea, years since menarche, years since sexual debut and number of sexual partners were associated with ectopy. In multivariate analysis with chlamydia infection as the dependent variable, women with ectopy had increased odds of having chlamydia infection (adjusted OR 1.78, p=0.033). In women under 19 years of age, we found twofold higher odds of being HIV-positive for those with ectopy (OR 2.19, p=0.014).

Conclusions In conclusion, cervical ectopy is associated with Chlamydia trachomatis infection and HIV in the youngest women.

  • HIV

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