Hyperendemic Chlamydia trachomatis sexually transmitted infections among females represent a high burden of asymptomatic disease and health disparity among Pacific Islanders in Fiji.

Background Chlamydia trachomatis is the most common bacterial sexually transmitted infection worldwide with some of the highest prevalence rates among Pacific Island Countries where syndromic management is practiced. However, little is known about the true prevalence and risk indicators for infectio...

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Bibliographic Details
Published in:PLOS Neglected Tropical Diseases
Main Authors: Virginia Svigals, Alden Blair, Santha Muller, Aalisha Sahu Khan, Daniel Faktaufon, Mike Kama, Torika Tamani, Laila Esfandiari, Mollie O'Brien, Deborah Dean
Format: Article in Journal/Newspaper
Language:English
Published: Public Library of Science (PLoS) 2020
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Online Access:https://doi.org/10.1371/journal.pntd.0008022
https://doaj.org/article/6adf278b725b47cbb2ca8bcbb7e7690a
Description
Summary:Background Chlamydia trachomatis is the most common bacterial sexually transmitted infection worldwide with some of the highest prevalence rates among Pacific Island Countries where syndromic management is practiced. However, little is known about the true prevalence and risk indicators for infection among neglected populations in these countries that suffer from health disparities. Methodology/principal findings Consecutive sampling was used to enroll sexually active females, aged 18-40 years, attending 12 Fijian Ministry of Health and Medical Services Health Centers and outreach locations from February to December, 2018. A Behavioral Surveillance Survey was administered to assess risk indicators for infection. Signs and symptoms were recorded, and vaginal swabs were tested for C. trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Candida and bacterial vaginosis. Bivariate and multivariate logistic regression analyses were performed using R-Studio. Of 577 participants, 103 (17.85%) were infected with C. trachomatis of whom 80% were asymptomatic and only 11 met criteria for syndromic management; 38.8% of infected women were 18-24 years old with a prevalence of 30.5%. 91.7% of participants intermittently or did not use condoms. C. trachomatis infection was associated with iTaukei ethnicity (OR 21.41 [95% CI: 6.38-133.53]); two lifetime partners (OR 2.12 [95% CI: 1.08-4.18]); and N. gonorrhoeae co-infection (OR 9.56 [95% CI: 3.67-28.15]) in multivariate analyses. Conclusions A disproportionately high burden of C. trachomatis is present among young asymptomatic women in Fiji of iTaukei ethnicity despite the low number of lifetime partners. Syndromic management and lack of barrier contraceptives contribute to hyperendemic levels. Strategic STI education and screening of at-risk adolescents, young women, and their partner(s) with appropriate treatment are urgently needed to control the epidemic.