Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2017

Open Access 01-12-2017 | Research article

Strong associations between national prevalence of various STIs suggests sexual network connectivity is a common underpinning risk factor

Author: Chris Kenyon

Published in: BMC Infectious Diseases | Issue 1/2017

Login to get access

Abstract

Background

If national peak Human Immunodeficiency Virus (HIV) prevalence is positively associated with the prevalence of other sexually transmitted infections (STIs) from before or early on in the HIV epidemics this would suggest common underlying drivers.

Methods

Pearson’s correlations were calculated between the prevalence of seven STIs at a country-level: chlamydia, gonorrhoea, trichomoniasis, syphilis, bacterial vaginosis, herpes simplex virus-2 (HSV-2) and HIV.

Results

The prevalence of all the STIs was highest in the sub-Saharan African region excluding chlamydia. The prevalence of all seven STIs were positively correlated excluding chlamydia. The correlations were strongest for HIV-HSV-2 (r = 0.85, P < 0.0001) and HSV-2-trichomoniasis (r = 0.82, P < 0.0001).

Conclusion

Our results of a generally positive association between the prevalences of a range of STIs suggests that higher prevalences were driven by common underlying determinants. We review different types of evidence which suggest that differential sexual connectivity is a plausible common determinant.
Literature
1.
Kenyon C, Buyze J. Should the threshold for generalized HIV epidemics be 1% or 5%? Int J STDs & AIDS. 2014;25:898.CrossRef
2.
Kenyon C, Colebunders R, Voeten H, Lurie M. Peak HIV prevalence: a useful outcome variable for ecological studies. Int J Infect Dis. 2013;17(5):e286–8.CrossRefPubMedPubMedCentral
3.
HIV/AIDS. JUNPo, Organization WH: AIDS epidemic update, 2006: World Health Organization; 2007.
4.
Goodreau SM, Cassels S, Kasprzyk D, Montano DE, Greek A, Morris M. Concurrent partnerships, acute infection and HIV epidemic dynamics among young adults in Zimbabwe. AIDS Behav. 2012;16(2):312–22.CrossRefPubMedPubMedCentral
5.
Morris M, Kurth AE, Hamilton DT, Moody J, Wakefield S. Concurrent partnerships and HIV prevalence disparities by race: linking science and public health practice. Am J Public Health. 2009;99(6):1023–31.CrossRefPubMedPubMedCentral
6.
Kenyon CR, Tsoumanis A, Schwartz IS, et al. Partner concurrency and HIV infection risk in South Africa. Int J Infect Dis 2016;45:81–7.
7.
Drain PK, Halperin DT, Hughes JP, Klausner JD, Bailey RC. Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries. BMC Infect Dis. 2006;6:172.CrossRefPubMedPubMedCentral
8.
Auvert B, Buve A, Ferry B, Carael M, Morison L, Lagarde E, Robinson NJ, Kahindo M, Chege J, Rutenberg N, et al. Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection. AIDS. 2001;15(Suppl 4):S15–30.CrossRefPubMed
9.
Auvert B, Buve A, Lagarde E, Kahindo M, Chege J, Rutenberg N, Musonda R, Laourou M, Akam E, Weiss H. Male circumcision and HIV infection in four cities in sub-Saharan Africa. AIDS. 2001;15:S31.CrossRefPubMed
10.
Buve A. The HIV epidemics in sub-Saharan Africa: why so severe? Why so heterogenous? An epidemiological perspective. The HIV/AIDS Epidemic in Sub-Saharan Africa Historical Perspective. 2006:41–55.
11.
Chesson HW, Dee TS, Aral SO. AIDS mortality may have contributed to the decline in syphilis rates in the United States in the 1990s. Sex Transm Dis. 2003;30(5):419–24.CrossRefPubMed
12.
Kenyon CR, Schwartz I, Buyze J. Did AIDS mortality decrease the number of lifetime sexual partners in Kenya: an ecological analysis? Epidemiol Infect. 2016;144(3):556–9.CrossRefPubMed
13.
Johnson LF, Dorrington RE, Bradshaw D, Coetzee DJ. The effect of syndromic management interventions on the prevalence of sexually transmitted infections in South Africa. Sex Reprod Healthc. 2011;2(1):13–20.CrossRefPubMed
14.
Kenyon CR, Osbak K, Buyze J, Chico RM. The changing relationship between bacterial STIs and HIV prevalence in South Africa - an ecological study. Int J STD AIDS. 2015;26(8):556-64. doi:10.​1177/​0956462414546392​.
15.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2095–128.CrossRefPubMed
16.
Institute for Health Metrics and Evaluation. Global burden of disease study 2010 (GBD 2010). Sexually transmitted infection prevalence 1990–2010. Seattle; 2011.
17.
Kenyon C, Colebunders R, Hens N. Determinants of generalized herpes simplex virus-2 epidemics: the role of sexual partner concurrency. Int J STD AIDS. 2013;24(5):375–82.CrossRefPubMed
18.
Looker KJ, Garnett GP, Schmid GP. An estimate of the global prevalence and incidence of herpes simplex virus type 2 infection. Bull World Health Organ. 2008;86(10):805–812, A.CrossRefPubMedPubMedCentral
19.
Smith JS, Robinson NJ. Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review. J Infect Dis. 2002;186(Supplement 1):S3–S28.CrossRefPubMed
20.
Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol. 2013;209(6):505–23.CrossRefPubMed
21.
Marrazzo JM, Martin DH, Watts DH, Schulte J, Sobel JD, Hillier SL, Deal C, Fredricks DN. Bacterial Vaginosis: identifying research gaps proceedings of a workshop sponsored by DHHS/NIH/NIAID November 19-20, 2008. Sex Transm Dis. 2010;37(12):732.CrossRefPubMedPubMedCentral
22.
UNAIDS. Methodology – understanding the HIV estimates. Geneva: UNAIDS; 2014.
23.
Gerbase A, Rowley J, Heymann D, Berkley S, Piot P. Global prevalence and incidence estimates of selected curable STDs. Sex Transm Infect. 1998;74(1):12.
24.
World Health Organization WHOOoI. Sexually transmitted infections increasing -- 250 million new infections annually. WHO Feature. 1990;152:1–6.
25.
Wylie JL, Shaw S, DeRubeis E, Jolly A. A network view of the transmission of sexually transmitted infections in Manitoba, Canada. Sex Transm Infect. 2010;86(Suppl 3):iii10–6.CrossRefPubMed
26.
Kenyon C, Colebunders R, Buyze J. Classification of incidence and prevalence of certain sexually transmitted infections by world regions. Int J of Infec Dis. 2014;18:73–80.CrossRef
27.
Osbak KK, Rowley JT, Kassebaum NJ, Kenyon CR. The prevalence of syphilis from the early HIV period is correlated with peak HIV prevalence at a country level. Sex Transm Dis. 2016;43(4):255–7.CrossRefPubMed
28.
World Health Organization. Global prevalence and incidence of selected curable sexually transmitted diseases: overview and estimates. Geneva: World Health Organization; 1995.
29.
World Health Organization. Global prevalence and incidence of selected curable sexually transmitted diseases: overview and estimates. Geneva: World Health Organization; 2001.
30.
World Health Organization. Prevalence and incidence of selected sexually transmitted infections, Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and Trichomonas vaginalis: methods and results used by the WHO to generate 2005 estimates. Geneva: World Health Organization; 2011.
31.
Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, Stevens G, Gottlieb S, Kiarie J, Temmerman M. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One. 2015;10(12):e0143304.CrossRefPubMedPubMedCentral
32.
Cal Ham D, Lin C, Newman L, Saman Wijesooriya N, Kamb M. Improving global estimates of syphilis in pregnancy by diagnostic test type: a systematic review and meta-analysis. Int J Gynecol Obstet. 2015;130(Suppl 1):S10–24.
33.
Kenyon CR, Osbak K, Tsoumanis A. The global epidemiology of syphilis in the past century - a systematic review based on antenatal syphilis prevalence. PLoS Negl Trop Dis. 2016;10(5):e0004711.CrossRefPubMedPubMedCentral
34.
Kenyon CR, Osbak K, Chico RM. What underpins the decline in syphilis in southern and eastern Africa? An exploratory ecological analysis. Int J Infect Dis. 2014;29:54–61.CrossRefPubMed
35.
Guthe T. The treponematoses as a world problem. Brit J Venereal Dis. 1960;36(2):67.
36.
Laga M, Nzila N, Goeman J. The interrelationship of sexually transmitted diseases and HIV infection: implications for the control of both epidemics in Africa. AIDS. 1991;5:S55.PubMed
37.
Cunningham A, Mindel A, Dwyer D. Global epidemiology of sexually transmitted diseases. In: Stanberry L, Bernstein D, editors. Sex transmitted diseases. San Diego: Academic Press; 2000.
38.
Bruni L, Diaz M, Castellsagué M, Ferrer E, Bosch FX, de Sanjosé S. Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010;202(12):1789–99.CrossRefPubMed
39.
Kenyon C, Osbak K, Buyze J. The prevalence of HIV by ethnic group is correlated with HSV-2 and syphilis prevalence in Kenya, South Africa, the United Kingdom and the United States. Interdiscipl Perspect Infect Dis. 2014;Article ID:284317.
40.
41.
Leiby GM, Turner TB, et al. Studies on syphilis in the eastern Health District of Baltimore city; syphilis among parturient women as an index of the trend of syphilis in the community. Am J Hyg. 1947;46(2):260–7.PubMed
42.
Gordon T, Devine B. Findings on the serologic test for syphilis in adults, United States 1960-1962. Vital Health Stat 11. 1965;11:1–31.PubMed
43.
Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. Epidemiology of syphilis in the United States, 1941-1993. Sex Transm Dis. 1996;23(1):16–23.CrossRefPubMed
44.
Vonderlehr R, Usilton LJ. Syphilis among men of draft age in the United States: an analysis of 1,895,778 serologic reports of men aged 21-35 who were examined under the selective training and service act of 1940. J Am Med Assoc. 1942;120(17):1369–72.CrossRef
45.
Fleming DT, McQuillan GM, Johnson RE, Nahmias AJ, Aral SO, Lee FK, St Louis ME. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med. 1997;337(16):1105–11.CrossRefPubMed
46.
Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ, Berman SM, Markowitz LE. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA. 2006;296(8):964–73.CrossRefPubMed
47.
O'Malley CK. Syphilis in South Africa. S Afr Med J. 1940;14(23):459–62.
48.
49.
South African Department of Health. The 2012 National Antenatal Sentinel HIV & Herpes Simplex Type-2 prevalence survey. In: National Department of health Pretoria; 2013.
50.
Central Bureau of Statistics (CBS) [Kenya] Ministry of Health (MOH) [Kenya] and ORC Macro: Kenya demographic and health survey 2003. In. Calverton, Maryland: CBS, MOH, and ORC; 2004.
51.
52.
Aral SO, Over M, Manhart L, Holmes KK. Sexually transmitted infections. In: Jamison DT, Mosley WH, editors. Disease control priorities in developing countries: health policy responses to epidemiological change. Volume 2. Washington (DC): World Bank; 2006. p. 653–89.
53.
Kenyon CR, Vu L, Menten J, Maughan-Brown B. Male circumcision and sexual risk behaviors may contribute to considerable ethnic disparities in HIV prevalence in Kenya: an ecological analysis. PLoS One. 2014;9(8):e106230.CrossRefPubMedPubMedCentral
54.
Drain PK, Smith JS, Hughes JP, Halperin DT, Holmes KK. Correlates of national HIV seroprevalence: an ecologic analysis of 122 developing countries. J Acquir Immune Defic Syndr. 2004;35(4):407–20.CrossRefPubMed
55.
Kenyon C, Buyze J. Correlation between National Peak HIV prevalence and concurrency, STI treatment capability, condom use and circumcision: an ecological study. World J AIDS. 2014;4(2):249–57.CrossRef
56.
Kenyon C. Association of HIV prevalence and concurrency of sexual partnerships in South Africa’s language groups: an ecological analysis. Southern African J HIV Med. 2013;14(1):25–8.CrossRef
57.
Vinod M, Medley A, Hong R, Gu Y, Robey B. Levels and Spread of HIV Seroprevalence and Associated Factors: Evidence from National Household Surveys. DHS Comparative Reports No. 22. Calverton: Macro International Inc.; 2009.
58.
Johnson LF, Dorrington RE, Bradshaw D, Pillay-Van Wyk V, Rehle TM. Sexual behaviour patterns in South Africa and their association with the spread of HIV: insights from a mathematical model. Demogr Res. 2009;21:289.CrossRef
59.
Kenyon C, Colebunders R. Strong association between point-concurrency and national peak HIV prevalence. Int J Infect Dis. 2012;16(11):e826–7.CrossRefPubMed
60.
Barnighausen T, Tanser F. Rethinking the role of the local community in HIV epidemic spread in sub-Saharan Africa: a proximate-determinants approach. HIV Ther. 2009;3(5):435–45.CrossRefPubMedPubMedCentral
61.
Kenyon CR, Buyze J, Klebanoff M, Brotman RM. Incident Trichomonas vaginalis is associated with partnership concurrency: a longitudinal cohort study. Sex Transm Dis. 2017;
62.
63.
Kenyon C, Colebunders R, Buve A, Hens N. Partner-concurrency associated with herpes simplex virus 2 infection in young South Africans. Int J STD AIDS. 2013;24:804–12.CrossRefPubMed
64.
Kenyon CR, Colebunders R. Strong association between the prevalence of bacterial vaginosis and male point-concurrency. Eur J Obstet Gynecol Reprod Biol. 2014;172:93–6.CrossRefPubMed
65.
Kenyon CR, Osbak K. The prevalence of syphilis is associated with the prevalence of male point-concurrency: an ecological analysis. World J AIDS. 2015;5(2):131–9.CrossRef
66.
Kenyon C, Zondo S. Why do some south African ethnic groups have very high HIV rates and others not? African J AIDS Res. 2011;10(1):51–62.CrossRef
67.
Delius P, Glaser C. The myths of polygamy: a history of extra-marital and multi-partnership sex in South Africa. South African Hist J. 2004;50(1):84–114.CrossRef
68.
Kirby D. Changes in sexual behaviour leading to the decline in the prevalence of HIV in Uganda: confirmation from multiple sources of evidence. Sex Transm Dis. 2008;84(Suppl 2):ii35–41.
Metadata
Title
Strong associations between national prevalence of various STIs suggests sexual network connectivity is a common underpinning risk factor
Author
Chris Kenyon
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2017
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-017-2794-x

Other articles of this Issue 1/2017

BMC Infectious Diseases 1/2017 Go to the issue

Research article

Evaluation of a field-deployable reverse transcription-insulated isothermal PCR for rapid and sensitive on-site detection of Zika virus

Correspondence

Beyond Ebola treatment units: severe infection temporary treatment units as an essential element of Ebola case management during an outbreak

Research article

Diagnostic dilemma of pulmonary tuberculosis among adults with severe mental illness in Beijing, China

Study protocol

Cardiovascular risk and endothelial function in people living with HIV/AIDS: design of the multi-site, longitudinal EndoAfrica study in the Western Cape Province of South Africa

Research article

Comparing tuberculosis management under public and private healthcare providers: Victoria, Australia, 2002–2015

Research article

Co-infection of Schistosoma mansoni/hepatitis C virus and their associated factors among adult individuals living in fishing villages, north-western Tanzania
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits