(P358) Sexually transmitted infection burden among cohabitating heterosexual couples in southern Uganda: a population-based study

Wednesday, July 26, 2023

16:00 – 18:00 CST

Primary Presenter(s)

TQ

Thomas C. Quinn

Rakai Health Sciences Program, Kalisizo, Uganda; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Department of Medicine, Johns Hopkins University, Baltimore; 9 Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States

Co-Author(s)

MG

M Kate Grabowski

Johns Hopkins University, United States

Co-author(s)

XF

Xinyi Feng

Johns Hopkins University, United States
JM

Josephine Mpagazi

Rakai Health Sciences Program, Kalisizo, Uganda, United States
AP

Austin D. Peer

Johns Hopkins University School of Medicine, Baltimore, MD, United States
YM

Yukari C. Manabe, MD

Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
CG

Charlotte A. Gaydos, BS, MS, MPH, DrPH

Professor
Johns Hopkins University
Gettysburg, Pennsylvania, United States
RG

Ronald Galiwango

Rakai Health Sciences Program, United States
CK

Caitlin Kennedy

Rakai Health Sciences Program, Kalisizo, Uganda; Department of Epidemiology, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
RS

Robert Ssekubugu

Rakai Health Sciences Program, Kalisizo, Uganda, United States
SR

Steven J. Reynolds

Rakai Health Sciences Program, Kalisizo, Uganda; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Department of Medicine, Johns Hopkins University, Baltimore; 9 Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
JJ

Jade Jackson

Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States
GK

Godfrey Kigozi

Rakai Health Sciences Program, Kalisizo, Uganda, United States
AT

Aaron AR Tobian

Department of Pathology, Johns Hopkins School of Medicine; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
JK

Joseph Kagaayi

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda, United States

Background: Data on sexually transmitted infection (STI) burden among sexual partners provide insight into STI epidemiology and risks of reinfection following treatment but are very rare particularly in resource limited settings with limited diagnostic capacity. Here, we measured burden of HIV, HSV-2, chlamydia, gonorrhea, trichomonas, and syphilis among cohabitating heterosexual couples in Uganda.

Methods: The Sexually Transmitted Infection Prevalence Study (STIPS) was a cross-sectional study of STI burden conducted in rural agrarian and Lake Victoria fishing populations in south central Uganda between May 2019 and October 2020. The study was nested in the Rakai Community Cohort Study (RCC), a population-based HIV surveillance cohort. Cohabitating couples in STIPS were identified through RCCS census and survey. STIPS participants were tested for HIV, HSV-2, and syphilis antibodies and chlamydia, gonorrhea, and trichomonas infections. High titer syphilis was defined as having a rapid plasma reagin (RPR) titer ≥1:8.

Results: There were 423 couples in STIPS. Median age of female partners was 29 years (IQR: 24-36) and male partners 36 years (IQR=29-41). In 157 (37%) couples, one or both partners tested positive for a curable STI (chlamydia, gonorrhea, trichomonas, or high titer syphilis). Sexual partners of participants with STIs had significantly higher burden of STIs compared to partners of those without STIs (Figure). For example, male partners of female participants with gonorrhea had 38% prevalence of gonorrhea compared to 2% prevalence among male partners of female participants without gonorrhea (Prevalence Ratio [PR]= 17.81; 95%CI:8.05 - 39.44). These same male partners of women with gonorrhea also had a higher burden of all other STIs including HIV (PR= 3.73; 95%CI:1.65 - 8.39), HSV-2 (PR=2.39; 95%CI:0.90 - 6.31), chlamydia (PR=2.6; 95%CI:1.03 - 6.73), trichomonas (PR=2.79; 95%CI:1.20 - 6.50), and high titer syphilis (PR=3.00; 95%CI:0.97 - 9.27). Similar observations were observed with other STIs and for female partners of male participants.

Conclusions: STI prevalence among couples in southern Uganda was high, with sexual partners of persons with STIs having extremely high STI burden. Effective diagnosis and treatment of STIs in sexual partners is necessary to reduce individual risk of reinfection with STIs and to effectively control STI epidemics.