Arch Gynecol Obstet (2005) 272: 67–73 DOI 10.1007/s00404-004-0689-8
O R I GI N A L A R T IC L E
Eyrun Floerecke Kjetland Æ Lovemore Gwanzura Patricia D. Ndhlovu Æ Takafira Mduluza Exnevia Gomo Æ Peter R. Mason Æ Nicholas Midzi Henrik Friis Æ Svein Gunnar Gundersen
Herpes simplex virus type 2 prevalence of epidemic proportions in rural Zimbabwean women: association with other sexually transmitted infections Received: 1 May 2004 / Accepted: 24 August 2004 / Published online: 13 January 2005 Ó Springer-Verlag 2005
Abstract Introduction: Syndromic management of sexually transmitted infections (STIs) is one important strategy in human immunodeficiency virus (HIV) prevention in developing countries, but there is a scarcity of rural community-based data on the relative prevalences of the STIs. We sought to determine the prevalences of the STIs and their clinical correlates in rural Zimbabwean women. Methods: A cross-sectional study was conducted among 527 sexually active, non-pregnant, non-menopausal women between the ages of 20 and 49 years. Results: The seroprevalence for herpes simplex virus type 2 (HSV-2), HIV, trichomoniasis and syphilis were 64.5, 29.3, 24.7 and 6.2% respectively. HSV-2 seropositivity was significantly associated with current non-syphilitic ulcers (adjusted odds ratio [OR] 4.91, 95% confidence interval [CI] 1.08–
E. F. Kjetland (&) Department of Infectious Diseases, Centre for Imported and Tropical Diseases, Ullevaal University Hospital, 0407 Oslo, Norway E-mail:
[email protected] Tel.: +47-97008579 L. Gwanzura Æ P. D. Ndhlovu Æ T. Mduluza Æ E. Gomo P. R. Mason College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe P. D. Ndhlovu Æ T. Mduluza Æ E. Gomo Æ N. Midzi Blair Research Institute, Harare, Zimbabwe P. R. Mason Biomedical Research and Training Institute, Harare, Zimbabwe H. Friis Department of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark S. G. Gundersen Department of Health and Sports, Agder University College, Kristiansand, Norway S. G. Gundersen Research Unit, Sorlandet Hospital, Kristiansand, Norway
22.34, p=0.040). HSV-2 seroprevalence peaked at the age of 35 whereas HIV peaked at 25. The two diseases were strongly associated (OR 2.92, 95% CI 1.85–4.65, p90%) and donovaniasis was not tested due to negligible prevalence in Zimbabwe [14]. Tests were done by Blair Research Institute, Biomedical Research and Training Institute (BRTI), Department of Medical Laboratory Sciences, Zimbabwe and by Medical Oncology, Department of Medicine, University of Antwerp. The Zimbabwean laboratories subscribe to Zimbabwe National Quality Assurance Programme.
b
Only patients with available specimens were tested, some sheets of clinical information were damaged in a car accident e Pick-up points and immediate area around the clinic f Surrounding area
Statistical methods The results of dichotomous variables are presented as prevalence levels. Odds ratio (OR) with 95% confidence interval (CI) was used when comparing prevalence in two groups of participants. In order to study simultaneously the impact of several variables, logistic regression analysis was used with a 5% significance level. The statistical analysis was computed using Statistical Package for the Social Sciences (SPSS) version 11 and EpiInfo2000.
Results Description of the population The mean age of the 527 included women was 34 years. The majority of the women were Shona (92%), Ndebele
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(1%) and the rest were of Malawian (5%) or Mozambiquan origin (2%). At the pick-up points and clinic area, 294 (83%) of the 353 women living there were enrolled, while in the surrounding area enrolment was 233 (33%) of the 706 women living there. The women from the pick-up points did not differ from women from the surrounding areas with respect to symptoms or diseases (Table 1). The results from the two subgroups have therefore been presented together. The ethnic groups did not differ with respect to any of the STIs, HIV or personal characteristics (data not shown). Virgins, pregnant, postmenopausal or menstruating women and those who refused to undergo gynaecological examination or participate, as well as those who had other serious diseases were excluded. Thus we excluded one woman who had rectal cancer, three who had cervical cancer, and one who did not agree to have a gynaecological examination. Ninety-three non-attendees were approached at home, 57 of these had an address at a pick up point. Amongst the non-attendees 14% had menstruated at the time of questioning, 9% were pregnant, 11% had left for one or several visits to other areas, 21% of the non-attendees declined to come, in approximately one third of these the husband pronounced the refusal, 37% were not found on three visits or were said to be busy in the fields, and 8% of the nonattendees listed by the VHW proved not to be within the target group. Of the 527 participating women 443 (84%) were married, 23 women (4%) were divorced, 8 (2%) were single, 39 (7%) were widowed, 6 of whom now cohabited with a new partner, most often with the late husband’s brother in accordance with the local tradition. In addition 13 (3%) non-widows cohabited. Widows had the same mean age as the rest of the participants. Sexually transmitted infections Each woman was tested for a median of seven STIs (range 1–8). Seventy-three percent (383 women) had a laboratory confirmed history or presence of minimum one STI of which HSV-2 was commonest (Table 1). Seven women tested positive for four STIs, 32 women for three STIs, 129 for two STIs. The remainder tested positive for one STI only. HSV-2 and past syphilis both peaked in the 30 to 39year age group with a prevalence of 71 and 8% respectively. HIV seropositivity peaked earlier in the 25 to 29year olds with a prevalence of 45% (Fig. 1). HIV was significantly associated with both HSV-2 (OR 2.93, 95% CI 1.85–4.65, p
