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Patterns of prevalent HPV and STI co-infections and associated factors among HIV-negative young Western Cape, South African women: the EVRI trial
  1. Lynette J Menezes1,
  2. Ubin Pokharel2,
  3. Staci L Sudenga2,
  4. Matthys H Botha3,
  5. Michele Zeier4,
  6. Martha E Abrahamsen2,
  7. Richard H Glashoff5,
  8. Susan Engelbrecht5,
  9. Maarten F Schim van der Loeff6,
  10. Louvina E van der Laan3,
  11. Siegfried Kipping3,
  12. Douglas Taylor7,
  13. Anna R Giuliano2
  1. 1 Division of Infectious Disease and International Medicine, University of South Florida, Tampa, Florida, USA
  2. 2 Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
  3. 3 Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
  4. 4 Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa
  5. 5 Division of Medical Virology, Stellenbosch University and NHLS Tygerberg, Cape Town, South Africa
  6. 6 Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
  7. 7 FHI 360, Durham, North Carolina, USA
  1. Correspondence to
    Dr Anna R Giuliano, Center for Infection Research in Cancer (CIRC), Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, USA; Anna.Giuliano{at}


Objective To estimate the prevalence and describe the patterns of concurrent human papillomavirus (HPV) and STIs and associated factors among HIV-negative young Western Cape, South African women participating in the Efficacy of HPV Vaccine to Reduce HIV Infection (EVRI) trial.

Methods HIV-negative women aged 16–24 years old were enrolled in the EVRI trial (NCT01489527) and randomised to receive the licensed four-valent HPV vaccine or placebo. At study entry, participants were clinically evaluated for five STIs: herpes simplex virus type 2 (HSV-2), chlamydia, gonorrhoea, syphilis and disease-causing HPV genotypes (6/11/16/18/31/33/35/39/45/51/52/56/58/59/68). Demographic and sexual history characteristics were compared among women with STI co-infections, single infection and no infection using Pearson χ2 and Mann-Whitney tests. ORs were calculated to evaluate factors associated with STI co-infection prevalence.

Results Among 388 young women, STI co-infection prevalence was high: 47% had ≥2 concurrent STIs, 36% had a single STI and 17% had none of the five evaluated STIs. HPV/HSV-2 (26%) was the most prevalent co-infection detected followed by HPV/HSV-2/Chlamydia trachomatis (CT) (17%) and HPV/CT (15%). Co-infection prevalence was independently associated with alcohol use (adjusted OR=2.01, 95% CI 1.00 to 4.06) and having a sexual partner with an STI (adjusted OR=6.96, 95% CI 1.53 to 30.08).

Conclusions Among high-risk young women from underserved communities such as in Southern Africa, a multicomponent prevention strategy that integrates medical and behavioural interventions targeting both men and women is essential to prevent acquisition of concurrent STI infections and consequent disease.

Trial registration number NCT01489527; Post-results.

  • HPV
  • HSV

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  • Handling editor Jackie A Cassell

  • Contributors ARG, LJM and SLS conceptualised study. ARG, LJM, UP and SLS contributed to data analyses. LJM and UP wrote manuscript. MHB and MZ directed data collection. RHG and SE performed laboratory analyses. All coauthors contributed to study design, interpretation of findings, reviewing and editing manuscript.

  • Funding This research was supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme. Merck (IISP39582) was the main sponsor of this trial and provided the study product. This work was also supported by the National Cancer Institute at the National Institutes of Health (Cancer Prevention Fellowship R25T CA147832 to SLS).

  • Competing interests ARG is a member of Merck research advisory boards. ARG and SLS received research funding from Merck. MFSvdL received research funding from Sanofi-Pasteur MSD; he is a co-investigator in a Sanofi-Pasteur-MSD HPV vaccine trial; he sat on a vaccine advisory board of GSK; his institution received in-kind contribution for an HPV study from Stichting Pathologie Onderzoek en Ontwikkeling; his institution receives research funding from Janssen Infectious Diseases and Vaccines.

  • Ethics approval Institutional Review Board, University of South Florida (number Pro00005120) and Health Research Ethics Committee, Stellenbosch University (number N11/06/174).

  • Provenance and peer review Not commissioned; externally peer reviewed.