Women and Sexually Transmitted Infections in Africa


Despite efforts to control the spread of sexually transmitted infections (STIs), these infections are still highly prevalent in the developing world, especially in Africa where the prevalence and incidence of Human immunodeficiency virus (HIV) is also very high. Unfortunately, women bear the disproportionate burden of both STIs and HIV in this region. Early diagnosis, treatment and prevention of STIs is therefore crucial in this population given the strong evidence that some STIs have been shown to facilitate the transmission of HIV. This review summarizes the epidemiology, and management of the common STIs affecting African women, and the health complications associated with these infections in the era of emerging antimicrobial resistance.

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Ramjee, G. , Abbai, N. and Naidoo, S. (2015) Women and Sexually Transmitted Infections in Africa. Open Journal of Obstetrics and Gynecology, 5, 385-399. doi: 10.4236/ojog.2015.57056.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Tang, V.A. and Rosenthal, K.L. (2010) Intravaginal Infection with Herpes Simplex Virus Type-2 (HSV-2) Generates a Functional Effector Memory T Cell Population That Persists in the Murine Genital Tract. Journal of Reproductive Immunology, 87, 39-44.
[2] Mayaud, P. and McCormick, D. (2001) Interventions against Sexually Transmitted Infections (STI) to Prevent HIV Infection. British Medical Bulletin, 58, 129-153.
[3] World Health Organization (2009) Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks.
[4] World Health Organization (2004) Reproductive Health Strategy to Accelerate Progress towards the Attainment of International Development Goals and Targets.
[5] Sachs, U. and Director, J. (2005) UN Millennium Project. Inventing in Development: A Practical Plan to Achieve the Millennium Development Goals. New York.
[6] Control, C.F.D. and Prevention (2011) Sexually Transmitted Diseases Treatment Guidelines, 2010. Annals of Emergency Medicine, 58, 67-68.
[7] Crowther-Gibson, P., Govender, N., Lewis, D., Bamford, C., Brink, A., Von Gottberg, A., Klugman, K., Du Plessis, M., Fali, A. and Harris, B. (2011) Part IV. Human Infections and Antibiotic Resistance. South African Medical Journal, 101, 567-578.
[8] Workowski, K.A. and Berman, S.M. (2011) Centers for Disease Control and Prevention Sexually Transmitted Disease Treatment Guidelines. Clinical Infectious Diseases, 53, S59-S63.
[9] World Health Organization (2008) Global Incidence and Prevalence of Selected Curable Sexually Transmitted Infections: Overview and Estimates. Geneva.
[10] Kaushic, C., Roth, K.L., Anipindi, V. and Xiu, F. (2011) Increased Prevalence of Sexually Transmitted Viral Infections in Women: The Role of Female Sex Hormones in Regulating Susceptibility and Immune Responses. Journal of Reproductive Immunology, 88, 204-209.
[11] Looker, K.J., Garnett, G.P. and Schmid, G.P. (2008) An Estimate of the Global Prevalence and Incidence of Herpes Simplex Virus Type 2 Infection. Bulletin of the World Health Organization, 86, 805A-812A.
[12] Aral, S. (2002) Understanding Racial-Ethnic and Societal Differentials in STI. Sexually Transmitted Infections, 78, 2-4.
[13] Gottlieb, S.L., Low, N., Newman, L.M., Bolan, G., Kamb, M. and Broutet, N. (2014) Toward Global Prevention of Sexually Transmitted Infections (STIs): The Need for STI Vaccines. Vaccine, 32, 1527-1535.
[14] Mylonas, I. (2012) Female Genital Chlamydia trachomatis Infection: Where Are We Heading? Archives of Gynecology and Obstetrics, 285, 1271-1285.
[15] Orroth, K., Korenromp, E., White, R., Changalucha, J., de Vlas, S., Gray, R., Hughes, P., Kamali, A., Ojwiya, A. and Serwadda, D. (2003) Comparison of STD Prevalences in the Mwanza, Rakai, and Masaka Trial Populations: The Role of Selection Bias and Diagnostic Errors. Sexually Transmitted Infections, 79, 98-105.
[16] Pepin, J., Deslandes, S., Khonde, N., Kintin, D., Diakité, S., Sylla, M., Méda, H., Sobela, F., Asamoah-Adu, C. and Agyarko-Poku, T. (2004) Low Prevalence of Cervical Infections in Women with Vaginal Discharge in West Africa: Implications for Syndromic Management. Sexually Transmitted Infections, 80, 230-235.
[17] Rassjo, E.-B., Kambugu, F., Tumwesigye, M.N., Tenywa, T. and Darj, E. (2006) Prevalence of Sexually Transmitted Infections among Adolescents in Kampala, Uganda, and Theoretical Models for Improving Syndromic Management. Journal of Adolescent Health, 38, 213-221.
[18] Kaul, R., Kimani, J., Nagelkerke, N.J., Fonck, K., Ngugi, E.N., Keli, F., MacDonald, K.S., Maclean, I.W., Bwayo, J.J. and Temmerman, M. (2004) Monthly Antibiotic Chemoprophylaxis and Incidence of Sexually Transmitted Infections and HIV-1 Infection in Kenyan Sex Workers: A Randomized Controlled Trial. The Journal of the American Medical Association, 291, 2555-2562.
[19] Sturm-Ramirez, K., Brumblay, H., Diop, K., Guèye-Ndiaye, A., Sankalé, J.-L., Thior, I., N’Doye, I., Hsieh, C.-C., Mboup, S. and Kanki, P.J. (2000) Molecular Epidemiology of Genital Chlamydia trachomatis Infection in High-Risk Women in Senegal, West Africa. Journal of Clinical Microbiology, 38, 138-145.
[20] Masese, L., Baeten, J.M., Richardson, B.A., Deya, R., Kabare, E., Bukusi, E., John-Stewart, G., Jaoko, W. and McClelland, R.S. (2013) Incidence and Correlates of Chlamydia trachomatis Infection in a High-Risk Cohort of Kenyan Women. Sexually Transmitted Diseases, 40, 221-225.
[21] Padian, N.S., van der Straten, A., Ramjee, G., Chipato, T., de Bruyn, G., Blanchard, K., Shiboski, S., Montgomery, E.T., Fancher, H. and Cheng, H. (2007) Diaphragm and Lubricant Gel for Prevention of HIV Acquisition in Southern African women: A Randomised Controlled Trial. The Lancet, 370, 251-261.
[22] Ramjee, G., Kapiga, S., Weiss, S., Peterson, L., Leburg, C., Kelly, C. and Masse, B. (2008) The Value of Site Preparedness Studies for Future Implementation of Phase 2/IIb/III HIV Prevention Trials: Experience from the HPTN 055 Study. Journal of Acquired Immune Deficiency Syndromes, 47, 93-100.
[23] Skoler-Karpoff, S., Ramjee, G., Ahmed, K., Altini, L., Plagianos, M.G., Friedland, B., Govender, S., De Kock, A., Cassim, N. and Palanee, T. (2008) Efficacy of Carraguard for Prevention of HIV Infection in Women in South Africa: A Randomised, Double-Blind, Placebo-Controlled trial. The Lancet, 372, 1977-1987.
[24] McCormack, S., Ramjee, G., Kamali, A., Rees, H., Crook, A.M., Gafos, M., Jentsch, U., Pool, R., Chisembele, M. and Kapiga, S. (2010) PRO2000 Vaginal Gel for Prevention of HIV-1 Infection (Microbicides Development PROGRAMME 301): A Phase 3, Randomised, Double-Blind, Parallel-Group Trial. The Lancet, 376, 1329-1337.
[25] Abdool Karim, S.S., Richardson, B.A., Ramjee, G., Hoffman, I.F., Chirenje, Z.M., Taha, T., Kapina, M., Maslan-kowski, L., Coletti, A. and Profy, A. (2011) Safety and Effectiveness of BufferGel and 0.5% PRO2000 Gel for the Prevention of HIV Infection in Women. AIDS, 25, 957-966.
[26] Radebe, F., Ricketts, C., Kekana, V., Vezi, A., Basson, I., Magooa, P., Bhojraj-Sewpershad, N., de Gita, G., Maseko, V. and Lewis, D. (2013) P3.291 Associations of Chlamydia trachomatis Infection in Men and Women with Genital Discharge Syndromes in Johannesburg, South Africa. Sexually Transmitted Infections, 89, A239-A240.
[27] Ohnishi, M., Golparian, D., Shimuta, K., Saika, T., Hoshina, S., Iwasaku, K., Nakayama, S.-I., Kitawaki, J. and Unemo, M. (2011) Is Neisseria gonorrhoeae Initiating a Future Era of Untreatable Gonorrhea? Detailed Characterization of the First Strain with High-Level Resistance to Ceftriaxone. Antimicrobial Agents and Chemotherapy, 55, 3538-3545.
[28] World Health Organization (2001) Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections: Overview and Estimates.
[29] Venkatesh, K.K., van der Straten, A., Mayer, K.H., Blanchard, K., Ramjee, G., Lurie, M.N., Chipato, T., Padian, N.S. and de Bruyn, G. (2011) African Women Recently Infected With HIV-1 and HSV-2 Have Increased Risk of Acquiring Neisseria gonorrhoeae and Chlamydia trachomatis in the Methods for Improving Reproductive Health in Africa Trial. Sexually Transmitted Diseases, 38, 562-570.
[30] Mlisana, K., Naicker, N., Werner, L., Roberts, L., van Loggerenberg, F., Baxter, C., Passmore, J.-A.S., Grobler, A.C., Sturm, A.W. and Williamson, C. (2012) Symptomatic Vaginal Discharge Is a Poor Predictor of Sexually Transmitted Infections and Genital Tract Inflammation in High-Risk Women in South Africa. Journal of Infectious Diseases, 206, 6-14.
[31] Abbai, N.S., Wand, H. and Ramjee, G. (2013) Sexually Transmitted Infections in Women Participating in a Biomedical Intervention Trial in Durban: Prevalence, Coinfections, and Risk Factors. Journal of Sexually Transmitted Diseases, 2013, Article ID: 358402.
[32] Abbai, N.S., Moodley, P., Reddy, T., Zondi, T., Rambaran, S., Naidoo, K. and Ramjee, G. (2015) Clinical Evaluation of the OneStep Gonorrhea RapiCardTM InstaTest for Detection of Neisseria gonorrhoeae in Symptomatic Patients from KwaZulu-Natal, South Africa. Journal of Clinical Microbiology, 53, 1348-1350.
[33] Van Damme, L., Ramjee, G., Alary, M., Vuylsteke, B., Chandeying, V., Rees, H., Sirivongrangson, P., Tshibaka, L.M., Etticgne-Traoré, V. and Uaheowitchai, C. (2002) Effectiveness of COL-1492, a Nonoxynol-9 Vaginal Gel, on HIV-1 Transmission in Female Sex Workers: A Randomised Controlled Trial. The Lancet, 360, 971-977.
[34] Johnson, L., Coetzee, D. and Dorrington, R. (2005) Sentinel Surveillance of Sexually Transmitted Infections in South Africa: A Review. Sexually Transmitted Infections, 81, 287-293.
[35] Pettifor, A.E., Kleinschmidt, I., Levin, J., Rees, H.V., MacPhail, C., Madikizela-Hlongwa, L., Vermaak, K., Napier, G., Stevens, W. and Padian, N.S. (2005) A Community-Based Study to Examine the Effect of a Youth HIV Prevention Intervention on Young People Aged 15 - 24 in South Africa: Results of the Baseline Survey. Tropical Medicine & International Health, 10, 971-980.
[36] Das, A., Pathni, A.K., Narayanan, P., George, B., Morineau, G., Saidel, T., Prabhakar, P., Deshpande, G.R., Gangakhedkar, R. and Mehendale, S. (2013) High Rates of Reinfection and Incidence of Bacterial Sexually Transmitted Infections in a Cohort of Female Sex Workers from Two Indian Cities: Need for Different STI Control Strategies? Sexually Transmitted Infections, 89, 5-10.
[37] Da Ros, C.T. and da Silva Schmitt, C. (2008) Global Epidemiology of Sexually Transmitted Diseases. Asian Journal of Andrology, 10, 110-114.
[38] Muzny, C.A. and Schwebke, J.R. (2013) The Clinical Spectrum of Trichomonas vaginalis Infection and Challenges to Management. Sexually Transmitted Infections, 89, 423-425.
[39] World Health Organization (2012) Global Incidence and Prevalence of Selected Curable Sexually Transmitted Infections—2008. WHO, Geneva.
[40] Sturm, A.W., Wilkinson, D., Ndovela, N., Bowen, S. and Connolly, C. (1998) Pregnant Women as a Reservoir of Undetected Sexually Transmitted Diseases in Rural South Africa: Implications for Disease Control. American Journal of Public Health, 88, 1243-1245.
[41] Watson-Jones, D., Changalucha, J., Gumodoka, B., Weiss, H., Rusizoka, M., Ndeki, L., Whitehouse, A., Balira, R., Todd, J. and Ngeleja, D. (2002) Syphilis in Pregnancy in Tanzania. I. Impact of Maternal Syphilis on Outcome of Pregnancy. Journal of Infectious Diseases, 186, 940-947.
[42] Buve, A., Weiss, H., Laga, M., Van Dyck, E., Musonda, R., Zekeng, L., Kahindo, M., Anagonou, S., Morison, L. and Robinson, N. (2001) The Epidemiology of Gonorrhoea, Chlamydial Infection and Syphilis in Four African Cities. AIDS, 15, S79-S88.
[43] Tenna, M., Aberra, G., Wondatir, N., Antoine, N. and Pierre, R.J. (2011) Prevalence of Trichomonas vaginalis Infections among Patients at Kiziba Refugee Camp and Centre Hospitalier Universitaire de Kigali (CHUK). KIST Journal of Science and Technology, 1, 31-38.
[44] Naidoo, S. and Wand, H. (2013) Prevalence and Incidence of Trichomonas vaginalis Infections in Women Participating in a Clinical Trial in Durban, South Africa. Sexually Transmitted Infections, 89, 519-522.
[45] Apalata, T., Carr, W.H., Sturm, W.A., Longo-Mbenza, B. and Moodley, P. (2014) Determinants of Symptomatic Vulvovaginal Candidiasis among Human Immunodeficiency Virus Type 1 Infected Women in Rural Kwazulu-Natal, South Africa. Infectious Diseases in Obstetrics and Gynecology, 2014, Article ID: 387070.
[46] Kapiga, S., Kelly, C., Weiss, S., Daley, T., Peterson, L., Leburg, C. and Ramjee, G. (2009) Risk Factors for Incidence of Sexually Transmitted Infections among Women in South Africa, Tanzania, and Zambia: Results from HPTN 055 Study. Sexually Transmitted Diseases, 36, 199-206.
[47] Etuketu, I.M., Mogaji, H., Alabi, O.M., Adeniran, A.A., Oluwole, A.S. and Ekpo, U.F. (2015) Prevalence and Risk Factors of Trichomonas vaginalis Infection among Pregnant Women Receiving Antenatal Care in Abeokuta, Nigeria. African Journal of Infectious Diseases, 9, 51-56.
[48] Crucitti, T., Jespers, V., Mulenga, C., Khondowe, S., Vandepitte, J. and Buvé, A. (2011) Non-Sexual Transmission of Trichomonas vaginalis in Adolescent Girls Attending School in Ndola, Zambia. PLoS ONE, 6, e16310.
[49] Francis, S.C., Ao, T.T., Vanobberghen, F.M., Chilongani, J., Hashim, R., Andreasen, A., Watson-Jones, D., Changalucha, J., Kapiga, S. and Hayes, R.J. (2014) Epidemiology of Curable Sexually Transmitted Infections among Women at Increased Risk for HIV in Northwestern Tanzania: Inadequacy of Syndromic Management. PLoS ONE, 9, e101221.
[50] Kuznik, A., Lamorde, M., Nyabigambo, A. and Manabe, Y.C. (2013) Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries: A Cost-Effectiveness Analysis. PLoS Medicine, 10, e1001545.
[51] Newman, L., Kamb, M., Hawkes, S., Gomez, G., Say, L., Seuc, A. and Broutet, N. (2013) Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data. PLoS Medicine, 10, e1001396.
[52] Todd, J., Munguti, K., Grosskurth, H., Mngara, J., Changalucha, J., Mayaud, P., Mosha, F., Gavyole, A., Mabey, D. and Hayes, R. (2001) Risk Factors for Active Syphilis and TPHA Seroconversion in a Rural African Population. Sexually Transmitted Infections, 77, 37-45.
[53] Vandenhoudt, H.M., Langat, L., Menten, J., Odongo, F., Oswago, S., Luttah, G., Zeh, C., Crucitti, T., Laserson, K. and Vulule, J. (2013) Prevalence of HIV and Other Sexually Transmitted Infections among Female Sex Workers in Kisumu, Western Kenya, 1997 and 2008. PLoS ONE, 8, e54953.
[54] Urassa, W.K., Kapiga, S.H., Msamanga, G.I., Antelman, G., Coley, J. and Fawzi, W.W. (2001) Risk Factors for Syphilis among HIV-1 Infected Pregnant Women in Dar es Salaam, Tanzania. African Journal of Reproductive Health, 54-62.
[55] Nakku-Joloba, E., Kambugu, F., Wasubire, J., Kimeze, J., Salata, R., Albert, J.M., Rimm, A. and Whalen, C. (2015) Sero-Prevalence of Herpes Simplex Type 2 Virus (HSV-2) and HIV Infection in Kampala, Uganda. African Health Sciences, 14, 782-789.
[56] De Baetselier, I., Menten, J., Cuylaerts, V., Ahmed, K., Deese, J., Van Damme, L. and Crucitti, T. (2015) Prevalence and Incidence Estimation of HSV-2 by Two IgG ELISA Methods among South African Women at High Risk of HIV. PLoS ONE, 10, e0120207.
[57] Ramjee, G., Williams, B., Gouws, E., Van Dyck, E., Deken, B.D. and Karim, S.A. (2005) The Impact of Incident and Prevalent Herpes Simplex Virus-2 Infection on the Incidence of HIV-1 Infection among Commercial Sex Workers in South Africa. Journal of Acquired Immune Deficiency Syndromes, 39, 333-339.
[58] Chohan, V., Baeten, J.M., Benki, S., Graham, S.M., Lavreys, L., Mandaliya, K., Ndinya-Achola, J.O., Jaoko, W., Overbaugh, J. and McClelland, R.S. (2009) A Prospective Study of Risk Factors for Herpes Simplex Virus Type 2 Acquisition among High-Risk HIV-1 Seronegative Women in Kenya. Sexually Transmitted Infections, 85, 489-492.
[59] Kapiga, S.H., Ewings, F.M., Ao, T., Chilongani, J., Mongi, A., Baisley, K., Francis, S., Andreasen, A., Hashim, R. and Watson-Jones, D. (2013) The Epidemiology of HIV and HSV-2 Infections among Women Participating in Microbicide and Vaccine Feasibility Studies in Northern Tanzania. PLoS ONE, 8, e68825.
[60] Masese, L., Baeten, J.M., Richardson, B.A., Bukusi, E., John-Stewart, G., Jaoko, W., Shafi, J., Kiarie, J. and McClelland, R.S. (2014) Incident Herpes Simplex Virus Type 2 Infection Increases the Risk of Subsequent Episodes of Bacterial Vaginosis. The Journal of Infectious Diseases, 209, 1023-1027.
[61] Kenyon, C., Colebunders, R., Buve, A. and Hens, N. (2013) P3.065 Partner-Concurrency Associated with HSV-2 Infection in Young South Africans. Sexually Transmitted Infections, 89, A168-A168.
[62] Abbai, N.S., Wand, H. and Ramjee, G. (2015) Socio-Demographic and Behavioural Characteristics Associated with HSV-2 Sero-Prevalence in High Risk Women in KwaZulu-Natal. BMC Research Notes, 8, 185.
[63] Weiss, H., Buve, A., Robinson, N., Van Dyck, E., Kahindo, M., Anagonou, S., Musonda, R., Zekeng, L., Morison, L. and Carael, M. (2001) The Epidemiology of HSV-2 Infection and Its Association with HIV Infection in Four Urban African Populations. AIDS, 15, S97-S108.
[64] Celum, C., Wald, A., Lingappa, J.R., Magaret, A.S., Wang, R.S., Mugo, N., Mujugira, A., Baeten, J.M., Mullins, J.I. and Hughes, J.P. (2010) Acyclovir and Transmission of HIV-1 from Persons Infected with HIV-1 and HSV-2. New England Journal of Medicine, 362, 427-439.
[65] Mugo, N., Dadabhai, S.S., Bunnell, R., Williamson, J., Bennett, E., Baya, I., Akinyi, N., Mohamed, I. and Kaiser, R. (2011) Prevalence of Herpes Simplex Virus Type 2 Infection, Human Immunodeficiency Virus/Herpes Simplex Virus Type 2 Coinfection, and Associated Risk Factors in a National, Population-Based Survey in Kenya. Sexually Transmitted Diseases, 38, 1059-1066.
[66] Freeman, E.E., Weiss, H.A., Glynn, J.R., Cross, P.L., Whitworth, J.A. and Hayes, R.J. (2006) Herpes Simplex Virus 2 Infection Increases HIV Acquisition in Men and Women: Systematic Review and Meta-Analysis of Longitudinal Studies. AIDS, 20, 73-83.
[67] Kirakoya-Samadoulougou, F., Nagot, N., Defer, M.-C., Yaro, S., Fao, P., Ilboudo, F., Langani, Y., Meda, N. and Robert, A. (2011) Epidemiology of Herpes Simplex Virus Type 2 Infection in Rural and Urban Burkina Faso. Sexually Transmitted Diseases, 38, 117-123.
[68] Glynn, J.R., Kayuni, N., Gondwe, L., Price, A.J. and Crampin, A.C. (2014) Earlier Menarche Is Associated with a Higher Prevalence of Herpes Simplex Type-2 (HSV-2) in Young Women in Rural Malawi. eLife, 3, e01604.
[69] Burd, E.M. (2003) Human Papillomavirus and Cervical Cancer. Clinical Microbiology Reviews, 16, 1-17.
[70] Allan, B., Marais, D.J., Hoffman, M., Shapiro, S. and Williamson, A.-L. (2008) Cervical Human Papillomavirus (HPV) Infection in South African Women: Implications for HPV Screening and Vaccine Strategies. Journal of Clinical Microbiology, 46, 740-742.
[71] Auvert, B., Marais, D., Lissouba, P., Zarca, K., Ramjee, G. and Williamson, A.-L. (2011) High-Risk Human Papillomavirus Is Associated with HIV Acquisition among South African Female Sex Workers. Infectious Diseases in Obstetrics and Gynecology, 2011.
[72] World Health Organization (2009) Human Papillomavirus Vaccines. Weekly Epidemiological Record, 84, 117-132.
[73] Tiggelaar, S.M., Lin, M.J., Viscidi, R.P., Ji, J. and Smith, J.S. (2012) Age-Specific Human Papillomavirus Antibody and Deoxyribonucleic Acid Prevalence: A Global Review. Journal of Adolescent Health, 50, 110-131.
[74] Smith, J.S., Melendy, A., Rana, R.K. and Pimenta, J.M. (2008) Age-Specific Prevalence of Infection with Human Papillomavirus in Females: A Global Review. Journal of Adolescent Health, 43, S5.e1-S5.e62.
[75] Ogembo, J.G., Manga, S., Nulah, K., Foglabenchi, L.H., Perlman, S., Wamai, R.G., Welty, T., Welty, E. and Tih, P. (2014) Achieving High Uptake of Human Papillomavirus Vaccine in Cameroon: Lessons Learned in Overcoming Challenges. Vaccine, 32, 4399-4403.
[76] Piras, F., Piga, M., De Montis, A., Zannou, A., Minerba, L., Perra, M.T., Murtas, D., Atzori, M., Pittau, M. and Maxia, C. (2011) Prevalence of Human Papillomavirus Infection in Women in Benin, West Africa. Virology Journal, 8, 514.
[77] Dempsey, A.F. (2008) Human Papillomavirus: The Usefulness of Risk Factors in Determining Who Should get Vaccinated. Reviews in Obstetrics and Gynecology, 1, 122-128.
[78] Abaasa, A., Crook, A., Gafos, M., Anywaine, Z., Levin, J., Wandiembe, S., Nanoo, A., Nunn, A., McCormack, S., Hayes, R., et al. (2013) LONG-Term Consistent Use of a Vaginal Microbicide Gel among HIV-1 Sero-Discordant Couples in a Phase III Clinical Trial (MDP 301) in Rural South-West Uganda. Trials, 14, 33.
[79] Reis Machado, J., da Silva, M.V., Cavellani, C.L., Reis, M., Monteiro, M.L.G., et al. (2014) Mucosal Immunity in the Female Genital Tract, HIV/AIDS. BioMed Research International, 2014, Article ID: 350195.
[80] Kleppa, E., Ramsuran, V., Zulu, S., Karlsen, G.H., Bere, A., Passmore, J.-A.S., Ndhlovu, P., Lillebo, K., Holmen, S.D. and Onsrud, M. (2014) Effect of Female Genital Schistosomiasis and Anti-Schistosomal Treatment on Monocytes, CD4+ T-Cells and CCR5 Expression in the Female Genital Tract. PLoS ONE, 9, e98593.
[81] Reddy, B., Rastogi, S., Das, B., Salhan, S., Verma, S. and Mittal, A. (2004) Cytokine Expression Pattern in the Genital Tract of Chlamydia trachomatis Positive Infertile Women—Implication for T-Cell Responses. Clinical & Experimental Immunology, 137, 552-558.
[82] Sperling, R., Kraus, T.A., Ding, J., Veretennikova, A., Lorde-Rollins, E., Singh, T., Lo, Y., Quayle, A.J. and Chang, T.L. (2013) Differential Profiles of Immune Mediators and in Vitro HIV Infectivity between Endocervical and Vaginal Secretions from Women with Chlamydia trachomatis Infection: A Pilot Study. Journal of Reproductive Immunology, 99, 80-87.
[83] Masson, L., Mlisana, K., Little, F., Werner, L., Mkhize, N.N., Ronacher, K., Gamieldien, H., Williamson, C., Mckinnon, L.R. and Walzl, G. (2014) Defining Genital Tract Cytokine Signatures of Sexually Transmitted Infections and Bacterial Vaginosis in Women at High Risk of HIV infection: A Cross-Sectional Study. Sexually Transmitted Infections, 90, 580-587.
[84] Mitchell, C., Balkus, J.E., McKernan-Mullin, J., Cohn, S.E., Luque, A.E., Mwachari, C., Cohen, C.R., Coombs, R., Frenkel, L.M. and Hitti, J. (2013) Associations between Genital Tract Infections, Genital Tract Inflammation and Cervical Cytobrush HIV-1 DNA in US Versus Kenyan Women. Journal of Acquired Immune Deficiency Syndromes, 62, 143-148.
[85] Cohen, C.R., Moscicki, A.-B. and Scott, M.E. (2010) Increased Levels of Immune Activation in the Genital Tract of Healthy Young Women from Sub-Saharan Africa. AIDS, 24, 2069-2074.
[86] Kaul, R., Cohen, C.R., Chege, D., Yi, T.J., Tharao, W., McKinnon, L.R., Remis, R., Anzala, O. and Kimani, J. (2011) Biological Factors that May Contribute to Regional and Racial Disparities in HIV Prevalence. American Journal of Reproductive Immunology, 65, 317-324.
[87] Wand, H. and Ramjee, G. (2015) Biological Impact of Recurrent Sexually Transmitted Infections on HIV Seroconversion among Women in South Africa: Results from Frailty Models. Journal of the International AIDS Society, 18, 19866.
[88] Stillwaggon, E. and Sawers, L. (2015) Rush to Judgment: The STI-Treatment Trials and HIV in Sub-Saharan Africa. Journal of the International AIDS Society, 18, 19844.
[89] Grosskurth, H., Todd, J., Mwijarubi, E., Mayaud, P., Nicoll, A., Newell, J., Mabey, D., Hayes, R., Mosha, F. and Senkoro, K. (1995) Impact of Improved Treatment of Sexually Transmitted Diseases on HIV Infection in Rural Tanzania: Randomised Controlled Trial. The Lancet, 346, 530-536.
[90] Wawer, M.J., Sewankambo, N.K., Serwadda, D., Quinn, T.C., Kiwanuka, N., Li, C., Lutalo, T., Nalugoda, F., Gaydos, C.A. and Moulton, L.H. (1999) Control of Sexually Transmitted Diseases for AIDS Prevention in Uganda: A Randomised Community Trial. The Lancet, 353, 525-535.
[91] Kamali, A., Quigley, M., Nakiyingi, J., Kinsman, J., Kengeya-Kayondo, J., Gopal, R., Ojwiya, A., Hughes, P., Carpenter, L. and Whitworth, J. (2003) Syndromic Management of Sexually-Transmitted Infections and Behaviour Change Interventions on Transmission of HIV-1 in Rural Uganda: A Community Randomised Trial. The Lancet, 361, 645-652.
[92] Gregson, S., Adamson, S., Papaya, S., Mundondo, J., Nyamukapa, C.A., Mason, P.R., Garnett, G.P., Chandiwana, S.K., Foster, G. and Anderson, R.M. (2007) Impact and Process Evaluation of Integrated Community and Clinic-Based HIV-1 Control: A Cluster-Randomised Trial in Eastern Zimbabwe. PLoS Medicine, 4, e102.
[93] Mullick, S., Watson-Jones, D., Beksinska, M. and Mabey, D. (2005) Sexually Transmitted Infections in Pregnancy: Prevalence, Impact on Pregnancy Outcomes, and Approach to Treatment in Developing Countries. Sexually Transmitted Infections, 81, 294-302.
[94] Malla, N. and Goyal, K. (2012) Sexually Transmitted Infections: An Overview. In: Malla, N., Ed., Sexually Transmitted Infections, Chap. 1, InTech.
[95] Hoots, B.E., Peterman, T.A., Torrone, E.A., Weinstock, H., Meites, E. and Bolan, G.A. (2013) A Trich-y Question: Should Trichomonas vaginalis Infection be Reportable? Sex Transmitted Diseases, 40, 113-116.
[96] Secor, W.E. (2012) Trichomonas vaginalis: Treatment Questions and Challenges. Expert Review of Anti-Infective Therapy, 10, 107.
[97] Becker, M., Stephen, J., Moses, S., Washington, R., Maclean, I., Cheang, M., Isac, S., Ramesh, B.M., Alary, M. and Blanchard, J. (2010) Etiology and Determinants of Sexually Transmitted Infections in Karnataka State, South India. Sexually Transmitted Diseases, 37, 159-164.
[98] Moodley, P. and Sturm, A. (2004) Management of Vaginal Discharge Syndrome: How Effective Is Our Strategy? International Journal of Antimicrobial Agents, 24, 4-7.
[99] Grosskurth, H., Gray, R., Hayes, R., Mabey, D. and Wawer, M. (2000) Control of Sexually Transmitted Diseases for HIV-1 Prevention: Understanding the Implications of the Mwanza and Rakai Trials. The Lancet, 355, 1981-1987.
[100] Lewis, D.A. and Marumo, E. (2009) Revision of the National Guideline for First-Line Comprehensive Management and Control of Sexually Transmitted Infections: What’s New and Why? Southern African Journal of Epidemiology and Infection, 24, 6-9.
[101] Somani, J., Bhullar, V.B., Workowski, K.A., Farshy, C.E. and Black, C.M. (2000) Multiple Drug-Resistant Chlamydia trachomatis Associated with Clinical Treatment failure. Journal of Infectious Diseases, 181, 1421-1427.
[102] Centers for Disease Control and Prevention (2008) Sexually Transmitted Diseases: Chlamydia—CDC Fact Sheet, Inc.
[103] Hocking, J.S., Vodstrcil, L., Huston, W.M., Timms, P., Chen, M., Worthington, K., McIver, R. and Tabrizi, S.N. (2013) A Cohort Study of Chlamydia trachomatis Treatment Failure in Women: A Study Protocol. BMC Infectious Diseases, 13, 379.
[104] Hafner, L.M., Wilson, D.P. and Timms, P. (2014) Development Status and Future Prospects for a Vaccine against Chlamydia trachomatis Infection. Vaccine, 32, 1563-1571.
[105] Low, N., Unemo, M., Jensen, J.S., Breuer, J. and Stephenson, J.M. (2014) Molecular Diagnostics for Gonorrhoea: Implications for Antimicrobial Resistance and the Threat of Untreatable Gonorrhoea. PLoS Medicine, 11, e1001598.
[106] Lewis, D.A. and Lukehart, S.A. (2011) Antimicrobial Resistance in Neisseria gonorrhoeae and Treponema pallidum: Evolution, Therapeutic Challenges and the Need to Strengthen Global Surveillance. Sexually Transmitted Infections, 87, ii39-ii43.
[107] Moodley, P., Moodley, D. and Sturm, A.W. (2004) Ciprofloxacin Resistant Neisseria gonorrhoeae in South Africa. International Journal of Antimicrobial Agents, 24, 192-193.
[108] Yokoi, S., Deguchi, T., Ozawa, T., Yasuda, M., Ito, S.-I., Kubota, Y., Tamaki, M. and Maeda, S.-I. (2007) Threat to Cefixime Treatment for Gonorrhea. Emerging Infectious Diseases, 13, 1275-1277.
[109] Unemo, M., Golparian, D., Syversen, G., Vestrheim, D. and Moi, H. (2010) Two Cases of Verified Clinical Failures Using Internationally Recommended First-Line Cefixime for Gonorrhoea Treatment, Norway, 2010. Microscopy, 120, A121N.
[110] Ison, C., Hussey, J., Sankar, K., Evans, J. and Alexander, S. (2011) Gonorrhoea Treatment Failures to Cefixime and Azithromycin in England, 2010. Eurosurveillance, 16, pii=19833.
[111] Kirkcaldy, R.D., Bolan, G.A. and Wasserheit, J.N. (2013) CEphalosporin-Resistant Gonorrhea in North America. The Journal of the American Medical Association, 309, 185-187.
[112] Jerse, A.E., Bash, M.C. and Russell, M.W. (2014) Vaccines against Gonorrhea: Current Status and Future Challenges. Vaccine, 32, 1579-1587.
[113] Andrei, G., Lisco, A., Vanpouille, C., Introini, A., Balestra, E., van den Oord, J., Cihlar, T., Perno, C.F., Snoeck, R. and Margolis, L. (2011) Topical Tenofovir, a Microbicide Effective against HIV, Inhibits Herpes Simplex Virus-2 Replication. Cell Host & Microbe, 10, 379-389.
[114] Krawczyk, A., Arndt, M.A., Grosse-Hovest, L., Weichert, W., Giebel, B., Dittmer, U., Hengel, H., Jager, D., Schneweis, K.E. and Eis-Hubinger, A.M. (2013) Overcoming Drug-Resistant Herpes Simplex Virus (HSV) Infection by a Humanized Antibody. Proceedings of the National Academy of Sciences, 110, 6760-6765.
[115] Piret, J. and Boivin, G. (2011) Resistance of Herpes Simplex Viruses to Nucleoside Analogues: Mechanisms, Prevalence, and Management. Antimicrobial Agents and Chemotherapy, 55, 459-472.
[116] Bacon, T.H., Boon, R.J., Schultz, M. and Hodges-Savola, C. (2002) Surveillance for Antiviral-Agent-Resistant Herpes Simplex Virus in the General Population with Recurrent Herpes Labialis. Antimicrobial Agents and Chemotherapy, 46, 3042-3044.
[117] Bacon, T.H., Levin, M.J., Leary, J.J., Sarisky, R.T. and Sutton, D. (2003) Herpes Simplex Virus Resistance to Acyclovir and Penciclovir after Two Decades of Antiviral Therapy. Clinical Microbiology Reviews, 16, 114-128.
[118] Schwebke, J. R. and Barrientes, F.J. (2006) Prevalence of Trichomonas vaginalis Isolates with Resistance to Metronidazole and Tinidazole. Antimicrobial Agents and Chemotherapy, 50, 4209-4210.
[119] Rukasha, I., Ehlers, M. and Kock, M. (2013) P5.099 Metronidazole Antimicrobial Drug Resistance Testing of Trichomonas vaginalis Collected from Women Attending an Anti-Retroviral Clinic, Pretoria, South Africa. Sex Transmitted Infections, 89, A366-A366.
[120] Straface, G., Selmin, A., Zanardo, V., De Santis, M., Ercoli, A. and Scambia, G. (2012) Herpes Simplex Virus Infection in Pregnancy. Infectious Diseases in Obstetrics and Gynecology, 2012, Article ID: 385697.
[121] World Health Organization (2003) Guidelines for the Management of Sexually Transmitted Infections.
[122] Holmes, K.K., Levine, R. and Weaver, M. (2004) Effectiveness of Condoms in Preventing Sexually Transmitted Infections. Bulletin of the World Health Organization, 82, 454-461.
[123] Winer, R.L., Hughes, J.P., Feng, Q., O'Reilly, S., Kiviat, N.B., Holmes, K.K. and Koutsky, L.A. (2006) Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women. New England Journal of Medicine, 354, 2645-2654.
[124] Mash, R., Mash, B. and De Villiers, P. (2010) “Why Don’t You Just Use a Condom?”: Understanding the Motivational Tensions in the Minds of South African Women: Review Article. African Primary Health Care and Family Medicine, 2, 1-4.
[125] Dochez, C., Bogers, J.J., Verhelst, R. and Rees, H. (2014) HPV Vaccines to Prevent Cervical Cancer and Genital Warts: An Update. Vaccine, 32, 1595-1601.
[126] Adewole, I.F., Abauleth, Y.R., Adoubi, I., Amorissani, F., Anorlu, R.I., Awolude, O.A., Botha, H., Byamugisha, J.K., Cisse, L. and Diop, M. (2013) Consensus Recommendations for the Prevention of Cervical Cancer in Sub-Saharan Africa. Southern African Journal of Gynaecological Oncology, 5, 47-57.
[127] Alam, N., Chamot, E., Vermund, S.H., Streatfield, K. and Kristensen, S. (2010) Partner Notification for Sexually Transmitted Infections in Developing Countries: A Systematic review. BMC Public Health, 10, 19.
[128] Low, N., Broutet, N., Adu-Sarkodie, Y., Barton, P., Hossain, M. and Hawkes, S. (2006) Global Control of Sexually Transmitted Infections. The Lancet, 368, 2001-2016.
[129] Mahmood, M. A. and Saniotis, A. (2011) Use of Syndromic Management Algorithm for Sexually Transmitted Infections and Reproductive Tract Infections Management in Community Settings in Karachi. Journal of the Pakistan Medical Association, 61, 453-457.
[130] Alary, M., Gbenafa-Agossa, C., Aina, G., Ndour, M., Labbé, A., Fortin, D., et al. (2006) Evaluation of a Rapid Point-of-Care Test for the Detection of Gonococcal Infection among Female Sex Workers in Benin. Sexually Transmitted Infections, 82, v29-v32.

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