(P468) Sexually Transmitted Infections and Bacterial Vaginosis among Women of Child-Bearing Age in Antananarivo, Madagascar: Prevalence and Risk Factors

Background: Sexually transmitted infections (STIs) and bacterial vaginosis (BV) can cause infertility, an increased risk of HIV acquisition, and pelvic inflammatory disease in women. Recent data on STIs and BV prevalence in the general population in Madagascar is scarce. Our objective is to estimate the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG), and BV among women and to determine the associated risk factors. We also aimed at determining the prevalence of resistance-associated mutations to macrolides and fluoroquinolones in MG.

Methods: We recruited women aged 18 to 45 years old consulting at the Teaching Hospital of Gynecology and obstetrics. We collected socio-demographic and risk factors data, and clinicians sampled vaginal swabs. STIs and BV were detected using qPCR and Nugent score, respectively. We explored factors associated with any STI using univariate and multivariate logistic regression. Finally, we performed sequencing of the 23S rRNA, GyrA, and ParC genes in MG.



Results: We recruited 491 women. The median age was 26.7 years (interquartile range: 23.0 - 32.3), 61.9% of the women were working and half of the women were married (237/491, 48.3%). Prevalence of CT, NG, TV, and BV was12.0% (95% Confidence Interval (CI): 9.3 - 15.2%), 4.3% (95%CI: 2.7 – 6.5%), 14.9% (95%CI: 11.8 – 18.3%) and 39.6% (95%CI: 35.2 - 44.1%), respectively. One-third (41/121) of women with at least one STI were asymptomatic. After controlling for confounding factors and mediators, we found evidence of an association between STIs and having sex in exchange for favors (money, job, gifts) (adjusted Odds Ratio (aOR): 4.50, 95%CI:1.28 – 15.8), having BV (aOR: 2.03 95%CI: 1.31 – 3.15), and having multiple partners in the past 12 months (aOR: 1.78 95%CI: 1.08 – 2.94). MG results are underway.



Conclusion: This study is the first one to be conducted on STIs in the female general population for over 20 years in Madagascar. STI prevalence in women in this study is relatively high and similar to that in East Africa. Prevention programs could target younger women stressing the risk of STI when having multiple partners or having sex in exchange for favors and encouraging condom use.