PT - JOURNAL ARTICLE AU - Sinead Delany-Moretlwe AU - Nyaradzo Mgodi AU - Linda-Gail Bekker AU - Jared M Baeten AU - Chuwen Li AU - Deborah Donnell AU - Yaw Agyei AU - Denni Lennon AU - Scott M Rose AU - Marcia Mokgatle AU - Sheetal Kassim AU - Shorai Mukaka AU - Adeola Adeyeye AU - Connie Celum TI - High prevalence and incidence of gonorrhoea and chlamydia in young women eligible for HIV pre-exposure prophylaxis in South Africa and Zimbabwe: results from the HPTN 082 trial AID - 10.1136/sextrans-2022-055696 DP - 2023 Mar 08 TA - Sexually Transmitted Infections PG - sextrans-2022-055696 4099 - http://sti.bmj.com/content/early/2023/03/07/sextrans-2022-055696.short 4100 - http://sti.bmj.com/content/early/2023/03/07/sextrans-2022-055696.full AB - Introduction We investigated the prevalence, incidence and factors associated with sexually transmitted infections (STIs) among young African women seeking HIV pre-exposure prophylaxis (PrEP).Methods HPTN 082 was a prospective, open-label PrEP study enrolling HIV-negative sexually active women aged 16–25 years in Cape Town and Johannesburg, South Africa, and Harare, Zimbabwe. Endocervical swabs from enrolment, months 6 and 12 were tested for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) by nucleic acid amplification, and Trichomonas vaginalis (TV) by a rapid test. Intracellular tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots were measured at months 6 and 12. Associations between risk characteristics and STI outcomes were assessed using Poisson regression.Results Of 451 enrolled participants, 55% had an STI detected at least once. CT incidence was 27.8 per 100 person-years (py) (95% CI 23.1, 33.2), GC incidence was 11.4 per 100 py (95% CI 8.5, 15.0) and TV incidence was 6.7 per 100 py (95% CI 4.5, 9.5). 66% of incident infections were diagnosed in women uninfected at baseline. Baseline cervical infection (GC or CT) risk was highest in Cape Town (relative risk (RR) 2.38, 95% CI 1.35, 4.19) and in those not living with family (RR 1.87, 95% 1.13, 3.08); condom use was protective (RR 0.67, 95% CI 0.45, 0.99). Incident CT was associated with baseline CT (RR 2.01; 95% CI 1.28, 3.15) and increasing depression score (RR 1.05; 95% CI 1.01, 1.09). Incident GC was higher in Cape Town (RR 2.40; 95% CI 1.18, 4.90) and in participants with high PrEP adherence (TFV-DP concentrations ≥700 fmol/punch) (RR 2.04 95% CI 1.02, 4.08).Conclusion Adolescent girls and young women seeking PrEP have a high prevalence and incidence of curable STIs. Alternatives to syndromic management for diagnosis and treatment are needed to reduce the burden of STIs in this population.Trial registration number NCT02732730.Data are available upon reasonable request.