Sexually transmitted infections, the silent partner in HIV-infected women in Zimbabwe

Lessons from a study we conducted at Newlands Clinic

Did you know you can have a sexually transmitted illness (STI) and not show any symptoms? We screened a random group of 385 women living with HIV who were attending Newlands Clinic Women’s Health Centre. 87% of these women did not have any symptoms for STIs. We tested them for gonorrhea, syphilis, herpes (HSV 2), chlamydia and trichomoniasis. 

After conducting some laboratory tests, we found that 61% of these predominantly middle aged women (with an average age of 41 years) had at least one of the STIs we tested for. Herpes (HSV 2) was the most common STI with half the women (53%) testing positive for it, followed by syphilis (11%), trichomoniasis (8%), chlamydia (2%) and gonorrhea (1%). 62% of those who tested positive for an STI other than HSV 2 did not have any STI symptoms. Women with more than three lifetime sex partners were three times more likely to test positive for an STI other than herpes. Those with tertiary education (college or university) were 90% less likely to test positive for an STI other than herpes. This study showed a high burden of STIs in a largely asymptomatic group of women living with HIV. This provokes a few thoughts:

1. While the U=U mantra meaning Undetectable (viral load) = untransmittable (HIV infection) needs to reach as many people as possible, it must be interpreted with caution particularly in settings where the burden of STIs is high since the presence of an STI also increases the chances of HIV infection and onward transmission even when the HIV viral load is undetectable
2. The same mantra might in fact be true for HIV transmission, but unprotected sex still exposes people to STIs which were quite high in our study group. Using a condom is still a great idea! Condomize!
3. With such a high burden of asymptomatic infections, the syndromic approach used to treat STIs in many resource limited settings would have missed all the asymptomatic women. We recommend routine screening particularly in the high risk groups for early detection and treatment of STIs.
4. Education of women was protective against STIs. Probably women who are educated are more confident or empowered to negotiate for safer sex.
5. The fewer sex partners the better. Seems like a no-brainer, but maybe a reminder to think twice before jumping into bed with the next partner! Take note though that the first or second sex partner may be carrying an STI, so protected sex is of utmost importance all the time.

This study was published in the Southern African Journal of HIV Medicine. If interested, you can read the full article.