Zizipho Z. A. Mbulawa

The cervicovaginal microflora plays a vital role in maintaining vaginal health, and disturbances can predispose women to opportunistic infections and sexually transmitted infections (STIs). This study examined the prevalence and associated factors of Candida species, bacterial vaginosis (BV), and their co-occurrence among women in the Eastern Cape province of South Africa. A cross-sectional design was employed, enrolling 325 women aged 18–60 years from a health facility in the Eastern Cape, South Africa. Candida species were identified in cervical specimens using a Seegene Allplex™ Candidiasis Assay. BV status and BV-associated bacteria were identified via Seegene Allplex™ Bacterial Vaginosis Plus assays. Overall, 64.51% of participants were HIV-positive, 15.74% tested positive for Candida species, 52.85% tested positive for BV, and 7.10% were positive for BV–Candida species co-occurrence. The highest prevalence of Candida species (23.60%; R² = 0.913; p = 0.015), BV (85.39%; R² = 0.931; p = 0.003), and Candida–BV co-occurrence (7.10%; R² = 0.903, p = 0.041) was observed in the 18–29 age group and declined significantly with age. Women with four to six lifetime sexual partners had higher odds of testing positive for Candida species (AOR: 2.42, 95% CI: 1.21–4.82, p = 0.012). Currently presenting with STI symptoms (AOR: 4.66; 95% CI: 1.29–16.87; p = 0.019), increased (four to six) lifetime sexual partners (AOR: 5.58; 95% CI: 1.16–26.82; p = 0.032), and being HPV-positive (AOR: 7.28; 95% CI: 1.17–45.26; p = 0.033) were independent predictors of Candida–BV co-occurrences. In this current study, having multiple lifetime sexual partners was independently associated with Candida species positivity, while current STI symptoms, HPV infection, and having four to six lifetime sexual partners significantly increased the likelihood of Candida–BV co-occurrence, highlighting the role of sexual behaviour in the vaginal microbial profile. This underscores the need for continued surveillance and longitudinal investigation. Longitudinal studies to further investigate these associations are warranted.

A community-engaged health outreach program is a temporary intervention designed to address health risks faced by a specific population. This report examines the impact of a community-engaged health outreach program conducted at the Tabase Clinic in Mthatha, Eastern Cape Province, South Africa. This tripartite health service, educational, and research outreach initiative was conceptualized and organized by Walter Sisulu University Faculty of Medicine and Health Sciences, National Health Laboratory Service, Eastern Cape Department of Health, and Tabase clinic committee. During the outreach, the Tabase clinic functioned as a one-stop multidisciplinary team polyclinic, comprising nurse-physician-paramedical teams from the Departments of Paediatrics, Urology, Surgery, Obstetrics and Gynaecology, Family Medicine, Physiotherapy, Pathology, Dentistry, Public Health, Social Work, Pharmacy, National Health Laboratory Service, Nursing, Orthotics and Prosthetics, and non-governmental organizations. There was a 6-fold increase in the number of clients who received healthcare at Tabase clinic during the outreach compared to regular days (from 50 to 60 to 388 clients). The attendees resided in villages that are up to 41 kilometers away from the Tabase clinic. The Tabase clinic catchment area has a high burden of hypertension, diabetes mellitus, epilepsy, pulmonary tuberculosis, extra-pulmonary tuberculosis (TB), asthma, schizophrenia, human immunodeficiency virus (HIV), cancer, cold, and flu. Males were the majority of attendees (53.1%) tested for HIV, a Men's Corner strategy attributed to this. Among those tested, 4.7% were newly diagnosed HIV cases, and clients were initiated on antiretroviral therapy. The health outreach also contributed to the learning of MBChB level four and six, honours, and masters’ students of the WSU Faculty of Medicine and Health Sciences. The major unmet need in the community was the lack of an ophthalmologist and an ear, nose, and throat specialist. All domains assessing perceptions of quality, relevance, and organization scored significantly above the neutral midpoint (Likert scale of 3; p < 0.05; R software, Version 4.3.1), confirming the strong acceptance of the program by the community. While logistics and educational delivery were not strongly scored. This outreach successfully bridged a vital gap in healthcare at the community level, enhancing community-based education and service.

Anal human papillomavirus (HPV) and cancer prevalence are increasing. Therefore, this study investigated the prevalence of anal HPV and associated risk factors, as well as HPV genotype-specific concordance at cervical and anal sites and associated risk factors among women of Eastern Cape Province, South Africa. A total of 326 women aged 18–60 were recruited from an Eastern Cape community health facility. HPV DNA was detected in cervical and anal specimens using the Seegene Anyplex™ and Allplex™ II HPV28 assay (Seegene Inc., Seoul, Republic of Korea), respectively. Anal HPV was detected in 68.1% (95% CI: 62.9–72.9) and independent predictors were cervical HPV positivity (AOR: 2.40, 95% CI: 1.39–4.14, p = 0.002), abnormal cytology (AOR: 3.12, 95% CI: 1.29–7.55, p = 0.012), single marital status (AOR: 3.55, 95% CI: 1.24–10.17, p = 0.018), and having more than three lifetime sexual partners (AOR: 1.75, 95% CI: 1.03–2.98, p = 0.039). Anal high risk (HR)-HPV types were detected in 50.9%, with HPV-58 (13.2%), HPV-68 (11.0%) and HPV-52 (9.2%) being the most dominant types. HPV genotype-specific cervical and anal concordance was observed in 33.5% of cases, with HPV-58 (7.1%), HPV-68 (4.9%), and HPV-35 (4.6%) being the most dominant. Women who were positive for cervical HPV infection (AOR: 3.24, 95% CI: 2.36–4.45, p < 0.001), anal HPV infection (AOR: 2.70, 95% CI: 2.01–3.63, p < 0.001) and abnormal cervical cytology (AOR: 2.01, 95% CI: 1.36–2.96, p < 0.001) had substantially higher odds of anal–cervical HPV concordance compared to those who were negative. High anal HPV prevalence and HPV genotype-specific anal and cervical concordance were observed among Eastern Cape women. Understanding anal HPV, HPV genotype-specific anal–cervical concordance, and associated factors can contribute to strategies towards anal HPV and associated disease prevention. These findings warrant further longitudinal investigation in future studies.

Background: Lactobacillus species are essential for vaginal eubiosis; their depletion often leads to dysbiosis, increasing susceptibility to sexually transmitted infections (STIs). This study investigated the prevalence of Candida albicans colonization and its associated factors among HIV-negative adolescent girls and young women (AGYW) in South Africa. Furthermore, STIs associated with C. albicans colonization and Lactobacillus deficiency were investigated. Methods: Secondary data analysis was performed on 138 HIV-negative AGYW of Eastern Cape province, South Africa. Secondary data included cervico-vaginal detected C. albicans , Lactobacillus species ( L. crispatus, L. gasseri or L. jensenii ), bacterial vaginosis, human papillomavirus (HPV), Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis , herpes simplex virus type 1/2 (HSV-1/2), and Mycoplasma genitalium , and behavioural questionnaires. Univariate and multivariate logistic regression were performed using GraphPad Prism Version 8.0.1.244. Results: A proportion of 27.58% were positive for C. albicans , and 84.06% tested positive for at least one investigated STI (73.91% for HPV, 31.16% for C. trachomatis , 12.32% for N. gonorrhoeae , 10.87% for T. vaginalis , 7.25% for HSV-1/2, and 5.80% for M. genitalium ). Frequent sexual intercourse (more than two times within the past 30 days) was associated with higher odds of C. albicans (OR: 1.84, 95% CI 1.85–3.80, p = 0.036), alcohol consumption (OR: 3.60, 95% CI 1.12–13.23, p = 0.038) and recent vaginal discharge syndrome (OR: 2.67, 95% CI 1.06–6.63, p = 0.005). Deficiency of Lactobacilli among C. albicans -positive AGYW was associated with increased odds of C. trachomatis positivity (OR: 4.37, 95% CI 1.05–17.05, p = 0.047). Conclusion: HIV-negative AGYW demonstrated a high burden of STIs, with C. albicans positivity associated with alcohol consumption, frequent sexual intercourse, and vaginal discharge syndrome. The absence of Lactobacilli was associated with increased odds of C. trachomatis positivity. Further research is recommended using longitudinal designs, larger sample sizes, and diverse populations to better understand these observations.

Background/Objectives: Vitamin D plays a role in cellular regulation and immune processes relevant to cervical carcinogenesis, yet data on vitamin D status and its determinants in high-burden settings such as South Africa remain scarce. This paper therefore describes the prevalence of vitamin D deficiency, insufficiency, and sufficiency, and explores associated factors among women with cervical lesions. Methods: A descriptive cross-sectional study was conducted among 103 women aged 18–81 years. Women were referred to Nelson Mandela Academic Hospital due to cervical cancer, high-grade squamous intraepithelial lesions (HSILs), or atypical squamous cells—cannot exclude HSIL, or low-grade squamous intraepithelial lesions, or atypical squamous cells of undetermined significance. The total serum 25(OH)D (D₂ + D₃) was quantified using the MAGLUMI 25-OH Vitamin D chemiluminescent immunoassay kit on the MAGLUMI X3 Fully Automatic Chemiluminescence Immunoassay Analyzer (Snibe Diagnostic, Shenzhen New Industries Biomedical Engineering Co., Ltd., Shenzhen, China). Serum vitamin D was categorized according to the Endocrine Society Task Force guidelines. Results: Vitamin D insufficiency was observed in 46.60% of participants and deficiency in 26.21% while only 27.18% had sufficient levels. Overall, vitamin D deficiency or insufficiency was more common than sufficiency (72.82%; 27.18%, p < 0.0001). Among HIV-positive women, 78.26% had vitamin D deficiency or insufficiency compared with 63.33% of HIV-negative women; however, this difference was not statistically significant. Vitamin D deficiency was most prevalent in women with healthy body mass index (BMI, 46.40%) values and decreased significantly with increasing BMI values (p = 0.008). Conclusions: Vitamin D deficiency and insufficiency were common among women with cervical lesions in this rural South African population. Associations with BMI suggest context-specific influences on vitamin D status. Owing to the study’s cross-sectional design and lack of normal cervical cytology participants, the findings are descriptive and exploratory, underscoring the need for longitudinal and comparative research to better define the role of vitamin D in cervical disease.

Continuous surveillance of human papillomavirus (HPV) prevalence and genotype distribution in different cervical cytology grades is necessary for cervical cancer prevention and monitoring. This study investigated the distribution of HPV genotypes and associated factors, stratified by cervical cytology grades and human immunodeficiency (HIV) status, among women in the Eastern Cape Province, South Africa. A total of 540 women were recruited from a community health facility and a referral hospital in the OR Tambo District Municipality in Eastern Cape Province. HPV detection and genotyping in cervical cells were performed using the Seegene Allplex^TM and Anyplex^TM II HPV28 assays. HPV prevalence was 60.6% among women with normal cervical cytology, 93.8% among atypical squamous cells of undetermined significance (ASC-US), 100.0% among low-grade squamous intraepithelial lesions (LSILs), 95.2% among atypical squamous cells cannot exclude high-grade lesion (ASC-H), 93.7% among high-grade squamous intraepithelial lesions (HSILs), and 92.5% among women with cervical cancer. HPV types targeted by Gardasil-9^® were detected in 36.0% of women with normal cervical cytology, 83.0% of those with HSIL, and 81.0% of those with cervical cancer. Among women with normal cervical cytology, HPV58, 35, and 68 were the most dominant types, HPV16, 33, and 35 in HSIL, and HPV16, 18, and 35 in cervical cancer. Differences were observed in the prevailing HPV genotype patterns when stratified by HIV infection status. This study highlights the high HPV prevalence, which further increased among women with abnormal cervical cytology. While HPV prevalence did not significantly increase with HIV co-infection, distinct differences were observed in the HPV genotype patterns when stratified by HIV status. The dominance of non-HPV vaccine types in HSIL and cervical cancer cases underscores a critical gap in current prevention strategies.

Ureaplasma species are associated with various reproductive health issues, while human papillomavirus (HPV) is associated with cervical, vaginal and vulvar cancers. Data on the association between Ureaplasma species and HPV are limited in South Africa. This study investigated the prevalence of Ureaplasma urealyticum (U. urealyticum), Ureaplasma parvum (U. parvum), and HPV coinfection and their associated factors, among adolescent girls and young women (AGYW) in the Eastern Cape Province, South Africa. A total of 214 participants were retrospectively recruited, and secondary data on HPV, U. urealyticum, U. parvum, demographics, and sexual behavior were used. HPV was detected using the Roche Linear Array HPV Genotyping Test, while U. urealyticum and U. parvum were detected using Allplex™ sexually transmitted infection (STI) essential Assay. Statistical analyses were performed using GraphPad Prism Version 8.0.1.244. The prevalence of U. urealyticum was 43.9% (94/214) and increased significantly with age (p = 0.036, R² = 0.8497); while U. parvum prevalence was 68.7% (147/214) and was not influenced by age. Having four to six lifetime sexual partners (PR: 1.77, 95% CI: 1.04–3.00, p = 0.043) was associated with increased risk of U. urealyticum. A proportion of 36.3% (77/212) had HPV-U. urealyticum coinfection and its risk was increased among those with 3–6 lifetime sexual partners (PR: 1.59, 95% CI: 1.10–2.53, p = 0.017), 2–4 new partners past three months (PR: 2.14, 95% CI: 1.19–2.42, p = 0.021); vaginal sexual intercourse frequency past 1-month (2–3 vaginal intercourse: PR: 1.54, 95% CI: 1.06–2.53, p = 0.037; 4–10 vaginal intercourse: PR: 1.91, 95% CI: 1.83–1.91, p = 0.005) and alcohol consumption (PR: 1.85, 95% CI: 1.20–3.28, p = 0.004). U. urealyticum positives had a significantly higher risk of HPV types targeted by Cervarix^® HPV vaccine than negatives (PR: 2.56, 95% CI: 1.23–5.37, p = 0.013), Gardasil^®4 (PR: 2.16, 95% CI: 1.25–3.75, p = 0.006) and Gardasil^®9 (PR: 1.70, 95% CI: 1.25–2.32, p = 0.001). AGYW of Eastern Cape Province, South Africa had high prevalence of U. urealyticum-HPV and U. parvum-HPV coinfections. Ureaplasma species coinfection was associated with HPV prevalence and distribution of genotypes. The U. urealyticum prevalence and its coinfection with HPV were associated with sexual behavior. Data from this study could contribute to the design of sexual health and STI interventions and could serve as a baseline for future epidemiological studies, which include ongoing surveillance of HPV genotype prevalence to evaluate the impact and effectiveness of HPV vaccination programs in the population.

Background/Objectives: Adolescent girls and young women (AGYW) have a high burden of sexually transmitted infections (STIs). This study examined the prevalence of Chlamydia trachomatis, its association with human papillomavirus (HPV), and other associated factors among AGYW of rural communities. Methods: Secondary data on C. trachomatis, HPV, and linked questionnaires from 214 sexually active AGYW were used. Self-collected vaginal specimens were previously tested using the Allplex™ STI Essential Assay and Roche Linear Array HPV genotyping assay. Results: The overall prevalence of C. trachomatis was 29.4% (63/214), and it was not influenced by age. The majority of the AGYW were C. trachomatis negative and HPV positive (52.4%, 111/212), followed by being C. trachomatis and HPV co-infected (23.6%, 50/212), C. trachomatis and HPV co-negative (18.4%, 39/212) and least were C. trachomatis positive and HPV negative (5.7%, 12/212). There was an increased prevalence of being HPV infected among C. trachomatis individuals than being C. trachomatis positive among HPV positive individuals (RR: 2.60, 95% CI: 2.00–3.38, p < 0.0001). C. trachomatis positive AGYW had a significantly higher association of HPV types targeted by Cervarix^® HPV vaccine (HPV-16 and/or -18) than C. trachomatis negatives (RR: 2.58, 95% CI: 1.37–4.82, p = 0.005), targeted by Gardasil^®4 HPV vaccine (HPV-6, -11, -16 and/or -18; RR: 2.21, 95% CI: 1.32–3.65, p = 0.005) and Gardasil^®9 HPV vaccine (HPV-6, -11, -16, -18, -31, -33, -45, -52 and/or -58; RR: 1.92, 95% CI: 1.37–2.67, p < 0.001). Conclusions: There was a high burden of C. trachomatis and HPV coinfection. C. trachomatis coinfection influenced HPV genotype prevalence and distribution, including those that are targeted by the current commercial HPV vaccines, suggesting that the high burden of C. trachomatis among AGYW may pose challenges to the ongoing HPV vaccination program. Integrated STI screening and prevention strategies are needed in rural South African settings.

Purpose: Bacterial vaginosis (BV) is associated with sexually transmitted infections (STIs), and it is highly prevalent among sub-Saharan African women. This study investigated the bacterial vaginosis (BV) prevalence, its effect on human papillomavirus (HPV), Chlamydia trachomatis , Neisseria gonorrhoea , Trachomonas vaginalis , Mycoplasma genitalium and herpes simplex virus 1/2 (HSV1/2) prevalence and associated factors among adolescent girls and young women (AGYW) of Eastern Cape province, South Africa. Methods: A total of 212 participants were retrospectively recruited from an HPV educational intervention study in Eastern Cape province. This study used secondary data on BV, HPV, C. trachomatis , N. gonorrhoea , T. vaginalis , M. genitalium and HSV1/2 and questionnaires. Associations between STIs, BV and other factors were assessed using GraphPad Prism version 8. Results: A proportion of 83.0% (176/212) AGYW were infected with ≥ 1 STI(s), and 44.3% (94/212) had BV. BV-negatives had a significantly lower prevalence of having 3–4 STIs than BV-positives (Prevalence Ratio (PR): 0.22, 95% CI: 0.08–0.57, p = 0.001). Compared to BV-negative with a significant amount of Lactobacillus species, BV-positive AGYW were more likely to have C. trachomatis (PR: 1.8, 95% CI: 1.0-3.2, p = 0.028); T. vaginalis (PR: 8.3, 95% CI: 1.1–62.3, p = 0.011) and vaginal discharge or itching (PR: 2.4, 95% CI: 1.2–4.8, p = 0.013). Smoking (PR: 1.6, 95% CI: 1.1–2.4, p = 0.008), having two lifetime partners (PR: 1.9, 95% CI: 1.2–3.1, p = 0.006), three lifetime partners (PR: 2.6, 95% CI: 1.3–5.2, p = 0.007) and new sexual partners past three-month (PR: 1.8, 1.2–2.7, p = 0.005) were the associated factors of BV. Conclusion: The bacterial vaginosis increased the risk of STIs and coinfection among AGYW. The presence and high amount of Lactobacillus species were associated with decreased risk of STIs. These findings indicate the urgent need to enhance BV and STI prevention, detection and management among AGYW.

Background: Sexually transmitted infections (STIs) are common globally, posing significant public health challenges and financial strain, especially in low- and middle-income countries. Sub-Saharan Africa (SSA) accounts for 40% of global STI prevalence, with South Africa having the highest rates of curable STIs and human immunodeficiency virus (HIV), both of which are closely linked to increasing HIV transmission risk and other STIs. Genital ulcer disease (GUD), primarily caused by HSV-1, HSV-2, and Treponema pallidum, and less frequently by Haemophilus ducreyi, Klebsiella granulomatis, and Chlamydia trachomatis, exemplifies the complex interplay of STIs. Methods: This study analyzed GUD and co-infection with HIV, testing patterns, and co-occurrence trends among public clinic attendees in Mthatha, South Africa, to identify demographic, behavioral, and occupational disparities. Results: Sex-specific analysis revealed higher HIV prevalence among female attendees (47.00%) compared to male attendees (22.00%), alongside notable testing gaps and disparities in diseases such as syphilis, genital herpes, and lymphogranuloma venereum (LGV). Age-specific trends indicated the highest HIV prevalence in individuals aged 30–49, with peaks at 66.67% (30–39) and 76.47% (40–49). Treponema pallidum and HSV-2 prevalence were most pronounced in younger age groups (Chlamydia trachomatis with HSV-1 (5.71%) and HSV-2 (4.76%), driven by shared risk factors. Correlation analysis identified strong links between HSV-1 and Haemophilus ducreyi (0.64) and between Chlamydia trachomatis and HSV-1 (0.56), underscoring the potential for integrated diagnostic strategies. Conclusion: These findings emphasize the need for targeted public health interventions addressing sex, age, and occupational disparities while improving diagnostic coverage and prevention efforts for co-occurring infections.