{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:53:19Z","timestamp":1787068399652,"version":"build-2736575974"},"reference-count":34,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T00:00:00Z","timestamp":1766620800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-004743"],"award-info":[{"award-number":["INV-004743"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,9,30]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>HIV pre-exposure prophylaxis (PrEP) programmes in Africa reach young women at risk of sexually transmitted infections (STIs). We evaluated curable STI prevalence, incidence and risk factors among women initiating PrEP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      From August to December 2022, sexually active women aged 16\u201330 years from 15 South African sites, and one site each in Eswatini, Kenya, Malawi, Uganda and Zambia were enrolled into the INSIGHT cohort and offered oral emtricitabine\/tenofovir PrEP with follow-up at 1, 3 and 6 months. At each visit, STI symptoms were assessed and treatment provided based on syndromic management or diagnostic testing. Diagnostic tests included nucleic acid amplification for\n                      <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                      and\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      , the rapid OSOM for\n                      <jats:italic>Trichomonas vaginalis<\/jats:italic>\n                      at enrolment and month 6, and serological testing for syphilis at enrolment using rapid plasma reagin with confirmatory\n                      <jats:italic>Treponema pallidum<\/jats:italic>\n                      particle agglutination. Prevalence and incidence of each STI were calculated, and predictors assessed using multivariable regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 3087 participants offered daily oral PrEP with a median age of 23 (IQR 21\u201327), 3011 had STI results and 30.9% had one or more\u2009STIs, with 15.7% reporting symptoms. The prevalence of\n                      <jats:italic>C. trachomatis<\/jats:italic>\n                      ,\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      ,\n                      <jats:italic>T. vaginalis<\/jats:italic>\n                      and syphilis was 20.8%, 6.8%, 6.0% and 4.4%, respectively. The incidence of one or more\u2009STIs (\n                      <jats:italic>C. trachomatis<\/jats:italic>\n                      ,\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      or\n                      <jats:italic>T. vaginalis<\/jats:italic>\n                      ) was 49.3\/100 person-years (95%\u2009CI 45.3 to 53.4) with 12.7% reporting symptoms. The incidence of\n                      <jats:italic>C. trachomatis<\/jats:italic>\n                      was 30.6\/100 person-years (95%\u2009CI 27.5 to 33.7),\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      10.8\/100 person-years (95%\u2009CI 9.0 to 12.6) and\n                      <jats:italic>T. vaginalis<\/jats:italic>\n                      11.5\/100 person-years (95%\u2009CI 9.7 to 13.4). An incident STI diagnosis was associated with low alcohol use (adjusted incidence rate ratio (aIRR) 1.3; 95%\u2009CI 1.0 to 1.6) and moderate alcohol use (aIRR 1.4; 95%\u2009CI 1.1 to 1.8), and having an STI diagnosed at enrolment (aIRR 1.8; 95%\u2009CI 1.5 to 2.1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The high prevalence and incidence of STIs among African women initiating PrEP, most of whom did not report symptoms, highlights the need for aetiologic testing to detect STIs, guide treatment and reduce reproductive health sequelae and risk of transmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      clinicaltrials.gov\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05746065\">NCT05746065<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056625","type":"journal-article","created":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T18:20:31Z","timestamp":1766686831000},"page":"364-371","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["High prevalence and incidence of curable sexually transmitted infections among young women using oral HIV pre-exposure prophylaxis in sub-Saharan Africa: results from the INSIGHT Cohort study"],"prefix":"10.1136","volume":"102","clinical-trial-number":[{"clinical-trial-number":"nct05746065","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05746065","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04644029","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3699-1841","authenticated-orcid":false,"given":"Irene","family":"Mukui","sequence":"first","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Peacock","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Donnell","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, USA"},{"name":"Fred Hutchinson Cancer Center, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Gati-Mirembe","sequence":"additional","affiliation":[{"name":"Makerere University-Johns Hopkins University Research Collaboration, Kampala, Central Region, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meighan","family":"Krows","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A","family":"Bukusi","sequence":"additional","affiliation":[{"name":"Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loveness","family":"Imaan","sequence":"additional","affiliation":[{"name":"Johns Hopkins Research Project-Kamuzu University of Health Sciences, Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Kotze","sequence":"additional","affiliation":[{"name":"Qhakaza Mbokodo Research Clinic, Ladysmith, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3372-9506","authenticated-orcid":false,"given":"Katherine Margaret","family":"Gill","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pippa","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Louw","sequence":"additional","affiliation":[{"name":"Madibeng Centre for Research, Brits, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjeetha","family":"Jaggernath","sequence":"additional","affiliation":[{"name":"Wits Maternal Adolescent and Child Health Research, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Marais","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit HIV Prevention Clinical Research Site, University of the Witwatersrand, Soweto, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remco P H","family":"Peters","sequence":"additional","affiliation":[{"name":"Foundation for Professional Development, Research Unit, East London, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0376-1019","authenticated-orcid":false,"given":"Sinead","family":"Delany-Moretlwe","sequence":"additional","affiliation":[{"name":"Wits RHI, University of the Witwatersrand, Hillbrow, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Ward","sequence":"additional","affiliation":[{"name":"Vuka Research Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"du Preez","sequence":"additional","affiliation":[{"name":"Vuka Research Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Kasaro","sequence":"additional","affiliation":[{"name":"University of North Carolina Global Projects Zambia, Lusaka, 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Sexually transmitted infections (stis). Geneva World Health Organization; 2023. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/sexually-transmitted-infections-(stis)"},{"key":"2026081808050878000_102.6.364.2","doi-asserted-by":"publisher","DOI":"10.1097\/qad.0000000000003163"},{"key":"2026081808050878000_102.6.364.3","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2020-054653"},{"key":"2026081808050878000_102.6.364.4","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2018-053597"},{"key":"2026081808050878000_102.6.364.5","doi-asserted-by":"crossref","first-page":"89","DOI":"10.36303\/SAGP.2022.3.3.0132","article-title":"Sexually transmissible infections: current approaches to management","volume":"3","author":"Mason","year":"2022","journal-title":"South African General Practitioner"},{"key":"2026081808050878000_102.6.364.6","unstructured":"World Health Organization . Updated recommendations for the treatment of neisseria gonorrhoeae, chlamydia trachomatis, and treponema pallidum and new recommendations on syphilis testing and partner services. Geneva World Health Organization; 2024. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240090767"},{"key":"2026081808050878000_102.6.364.7","doi-asserted-by":"publisher","DOI":"10.1038\/s41585-021-00527-4"},{"key":"2026081808050878000_102.6.364.8","first-page":"A205","article-title":"P432 High prevalence and incidence of curable STIs among young women initiating PrEP in a township in south africa","volume":"95","author":"Gill","year":"2019","journal-title":"Sex Transm Infect"},{"key":"2026081808050878000_102.6.364.9","first-page":"A202","article-title":"P424 High prevalence and incidence of bacterial STIs in young women at high risk of HIV prior to PrEP scale-up in kenya","volume":"95","author":"Stewart","year":"2019","journal-title":"Sex Transm Infect"},{"key":"2026081808050878000_102.6.364.10","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2022-055696"},{"key":"2026081808050878000_102.6.364.11","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.17134","article-title":"Global Epidemiologic Characteristics of Sexually Transmitted Infections Among Individuals Using Preexposure Prophylaxis for the Prevention of HIV Infection: A Systematic Review and Meta-analysis","volume":"2","author":"Ong","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026081808050878000_102.6.364.12","unstructured":"World Health Organization . Implementation tool for pre-exposure prophylaxis of HIV infection: integrating sti services. Geneva World Health Organization; 2023. 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The diagnostics landscape for sexually transmitted infections. Geneva World Health Organization; 2023. 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