{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T07:11:53Z","timestamp":1787987513690,"version":"build-2784847793"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"crossref","award":["384709"],"award-info":[{"award-number":["384709"]}],"id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Health Laboratory Service Research Trust"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiologia"],"abstract":"<jats:p>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\u2122 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\u20133.38, p &lt; 0.0001). C. trachomatis positive AGYW had a significantly higher association of HPV types targeted by Cervarix\u00ae HPV vaccine (HPV-16 and\/or -18) than C. trachomatis negatives (RR: 2.58, 95% CI: 1.37\u20134.82, p = 0.005), targeted by Gardasil\u00ae4 HPV vaccine (HPV-6, -11, -16 and\/or -18; RR: 2.21, 95% CI: 1.32\u20133.65, p = 0.005) and Gardasil\u00ae9 HPV vaccine (HPV-6, -11, -16, -18, -31, -33, -45, -52 and\/or -58; RR: 1.92, 95% CI: 1.37\u20132.67, p &lt; 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.<\/jats:p>","DOI":"10.3390\/epidemiologia6040079","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T10:56:47Z","timestamp":1762945007000},"page":"79","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Chlamydia trachomatis Infection and Its Association with Human Papillomavirus Among Adolescent Girls and Young Women of Eastern Cape, South Africa"],"prefix":"10.3390","volume":"6","author":[{"given":"Olufunmilayo O.","family":"Akapo","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha 5100, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9073-4777","authenticated-orcid":false,"given":"Zizipho Z. A.","family":"Mbulawa","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha 5100, South Africa"},{"name":"National Health Laboratory Service, Nelson Mandela Academic Hospital, Mthatha 5100, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"103210","DOI":"10.1016\/j.eclinm.2025.103210","article-title":"Prevalence of chlamydia, gonorrhoea, and trichomoniasis among male and female general populations in sub-Saharan Africa from 2000 to 2024: A systematic review and meta-regression analysis","volume":"83","author":"Michalow","year":"2025","journal-title":"EClinicalMedicine"},{"key":"ref_2","unstructured":"(2025, July 16). WHO Sexually Transmitted Infections (STIs). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/sexually-transmitted-infections-(stis)."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1177\/0956462420915388","article-title":"Estimating prevalence and incidence of sexually transmitted infections among South African women: Implications of combined impacts of risk factors","volume":"31","author":"Wand","year":"2020","journal-title":"Int. J. STD AIDS"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1097\/OLQ.0000000000001871","article-title":"Prevalence of curable sexually transmitted infections in a population-representative sample of young adults in a high HIV incidence area in South Africa","volume":"50","author":"Jarolimova","year":"2023","journal-title":"Sex. Transm. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Mbulawa, Z.Z.A., Somdyala, N.I., Mabunda, S.A., and Williamson, A.-L. (2021). High human papillomavirus prevalence among females attending high school in the Eastern Cape Province of South Africa. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0253074"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"313","DOI":"10.7196\/SAMJ.6514","article-title":"Age-specific prevalence of cervical human papillomavirus infection and cytological abnormalities in women in Gauteng Province, South Africa","volume":"103","author":"Richter","year":"2013","journal-title":"S. Afr. Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Dabee, S., Barnabas, S., Versteeg, B., Kullin, B., Jaumdally, S.Z., Gamieldien, H., Mkhize, N., Muller, E., Maseko, V., and Gill, K. (2025). High Prevalence and Genotypic Diversity of Persistent Chlamydia trachomatis Infections Among South African Adolescent Girls and Young Women: A Tale of Two Cities. medRxiv.","DOI":"10.1101\/2025.01.17.25320646"},{"key":"ref_8","first-page":"a1450","article-title":"Erratum: Southern African HIV Clinicians Society 2022 guideline for the management of sexually transmitted infections: Moving towards best practice","volume":"23","author":"Peters","year":"2022","journal-title":"S. Afr. J. HIV Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"251","DOI":"10.21106\/ijma.523","article-title":"Genital Chlamydia Trachomatis infection: Prevalence, risk factors and adverse pregnancy and birth outcomes in children and women in sub-Saharan Africa","volume":"10","author":"Ebiringa","year":"2021","journal-title":"Int. J. Matern. Child. Health AIDS"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kaida, A., Dietrich, J.J., Laher, F., Beksinska, M., Jaggernath, M., Bardsley, M., Smith, P., Cotton, L., Chitneni, P., and Closson, K. (2018). A high burden of asymptomatic genital tract infections undermines the syndromic management approach among adolescents and young adults in South Africa: Implications for HIV prevention efforts. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3380-6"},{"key":"ref_11","first-page":"27","article-title":"Cervical Cancer Screening Guidelines for South Africa","volume":"1","author":"Botha","year":"2023","journal-title":"Afr. J. Obstet. Gynaecol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kombe Kombe, A.J., Li, B., Zahid, A., Mengist, H.M., Bounda, G.-A., Zhou, Y., and Jin, T. (2021). Epidemiology and burden of human papillomavirus and related diseases, molecular pathogenesis, and vaccine evaluation. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.552028"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lu, Y., Wu, Q., Wang, L., and Ji, L. (2024). Chlamydia trachomatis enhances HPV persistence through immune modulation. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09094-6"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"509","DOI":"10.2217\/fmb-2019-0242","article-title":"Protein\u2013protein interactions of HPV\u2013Chlamydia trachomatis\u2013human and their potential in cervical cancer","volume":"15","author":"Khan","year":"2020","journal-title":"Future Microbiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e25346","DOI":"10.1002\/jia2.25346","article-title":"Mechanisms of sexually transmitted infection--induced inflammation in women: Implications for HIV risk","volume":"22","author":"Mwatelah","year":"2019","journal-title":"J. Int. Aids Soc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s11904-025-00749-w","article-title":"Sexually Transmitted Infections and Risk of Human Immunodeficiency Virus Transmission","volume":"22","author":"Wilkerson","year":"2025","journal-title":"Curr. HIV\/AIDS Rep."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chen, H., Luo, L., Wen, Y., He, B., Ling, H., Shui, J., He, P., Hou, X., Tang, S., and Li, Z. (2020). Chlamydia trachomatis and Human Papillomavirus Infection in Women From Southern Hunan Province in China: A Large Observational Study. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.00827"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4891","DOI":"10.7150\/jca.58582","article-title":"Chlamydia trachomatis infection: Their potential implication in the etiology of cervical cancer","volume":"12","author":"Yang","year":"2021","journal-title":"J. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Sharma, V., and Khan, M.M. (2025). Current Progress and Future Perspective of Chlamydia trachomatis Infection: A Rising Threat to Women Health. Curr. Microbiol., 82.","DOI":"10.1007\/s00284-025-04287-x"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"425","DOI":"10.9745\/GHSP-D-18-00090","article-title":"Human papillomavirus vaccine introduction in South Africa: Implementation lessons from an evaluation of the national school-based vaccination campaign","volume":"6","author":"Kelley","year":"2018","journal-title":"Glob. Health Sci. Pract."},{"key":"ref_21","unstructured":"(2025, July 16). WHO HPV Dashboard. Available online: https:\/\/www.who.int\/teams\/immunization-vaccines-and-biologicals\/diseases\/human-papillomavirus-vaccines-(HPV)\/hpv-clearing-house\/hpv-dashboard."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1099\/jmm.0.000245","article-title":"HPV genotypes distribution in Chlamydia trachomatis co-infection in a large cohort of women from north-east Italy","volume":"65","author":"Seraceni","year":"2016","journal-title":"J. Med. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Onywera, H., Mabunda, S.A., Williamson, A.-L., and Mbulawa, Z.Z. (2022). Microbiological and behavioral determinants of genital HPV infections among adolescent girls and young women warrant the need for targeted policy interventions to reduce HPV risk. Front. Reprod. Health, 4.","DOI":"10.3389\/frph.2022.887736"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1136\/sextrans-2022-055696","article-title":"High prevalence and incidence of gonorrhoea and chlamydia in young women eligible for HIV pre-exposure prophylaxis in South Africa and Zimbabwe: Results from the HPTN 082 trial","volume":"99","author":"Mgodi","year":"2023","journal-title":"Sex. Transm. Infect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1002\/ijgo.15529","article-title":"Sexually transmitted infec-tions in pregnancy and adverse pregnancy outcomes: A retrospective cohort study","volume":"166","author":"Govender","year":"2024","journal-title":"Int. J. Gy-Necol. Obstet."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Abbai, N.S., Wand, H., and Ramjee, G. (2016). Biological factors that place women at risk for HIV: Evidence from a large-scale clinical trial in Durban, South Africa. BMC Women\u2019s Health, 16.","DOI":"10.1186\/s12905-016-0295-5"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Akinyi, I., Awandu, S.S., Broeck, D.V., Pereira, A.R., Redzic, N., and Bogers, J. (2024). Prevalence and genotypic distribution of human papillomavirus among women attending reproductive health clinics in in lake victoria basin-kenya: A cross-sectional study. BMC Womens Health, 24.","DOI":"10.1186\/s12905-024-03303-9"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"26282","DOI":"10.3402\/gha.v8.26282","article-title":"Health systems challenges in cervical cancer prevention program in Malawi","volume":"8","author":"Maseko","year":"2015","journal-title":"Glob. Health Action"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1177\/09564624221118721","article-title":"Prevalence of Chlamydia trachomatis infection in pregnant women from Durban, South Africa","volume":"33","author":"Mabaso","year":"2022","journal-title":"Int. J. STD AIDS"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Pavone, G., Marino, A., Fisicaro, V., Motta, L., Spata, A., Martorana, F., Spampinato, S., Celesia, B.M., Cacopardo, B., and Vigneri, P. (2024). Entangled connections: HIV and HPV interplay in cervical cancer\u2014A comprehensive review. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms251910358"},{"key":"ref_31","first-page":"1947","article-title":"The impact of female genital tract infections on HIV acquisition in South Africa","volume":"206","author":"Wand","year":"2012","journal-title":"J. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kutz, J.M., Rausche, P., Gheit, T., Puradiredja, D.I., and Fusco, D. (2023). Barriers and facilitators of HPV vaccination in sub-saharan Africa: A systematic review. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-15842-1"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1080\/08870446.2022.2090560","article-title":"Sexually transmitted infection prevention behaviours: Health impact, prevalence, correlates, and interventions","volume":"38","author":"Adam","year":"2023","journal-title":"Psychol. Health"}],"container-title":["Epidemiologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-3986\/6\/4\/79\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T05:23:28Z","timestamp":1763097808000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-3986\/6\/4\/79"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,12]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["epidemiologia6040079"],"URL":"https:\/\/doi.org\/10.3390\/epidemiologia6040079","relation":{},"ISSN":["2673-3986"],"issn-type":[{"value":"2673-3986","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,12]]}}}