Prevalence of bacterial vaginosis, sexually transmitted infections and their association with HPV infections in asymptomatic women attending antenatal care in Ethiopia

Sexually transmitted infections (STIs) and human papillomavirus (HPV) infections are common among women of reproductive age and can lead to infertility, adverse pregnancy outcomes, neonatal infections and cervical cancer. In countries with limited medical coverage, untreated infections contribute to high morbidity. This study aimed to expand the current knowledge on the prevalence of bacterial vaginosis (BV) and STIs in pregnant Ethiopian women and assess the association of these conditions with HPV infections. Socio-demographic data and vaginal lavage samples were collected from 779 asymptomatic women aged 18 to 45 years (median age, 25.9 years) attending antenatal care in seven centres across Ethiopia. Multiplex polymerase chain reaction was used to test for BV, <i>Chlamydia trachomatis</i>, <i>Trichomonas vaginalis</i>, <i>Neisseria gonorrhoeae</i>, herpes simplex virus types 1 and 2 (HSV-1/2), <i>Mycoplasma</i>, <i>Ureaplasma</i>, <i>Candida species</i> and HPV. Overall, 26.8% (95% confidence interval (CI): 23.7-29.9) of women tested positive for BV or one of the following STIs: <i>C. trachomatis</i>, <i>T. vaginalis</i>, <i>N. gonorrhoeae</i>, <i>Mycoplasma genitalium</i>, HSV-1/2 or <i>Ureaplasma urealyticum</i>. Additionally, 22.1% tested positive for at least one high-risk HPV type. <i>Chlamydia trachomatis</i> and HSV-2 were significantly more common among women who were positive for HPV and high-risk HPV. This study reveals a high prevalence of asymptomatic pregnant women who are positive for BV, STIs or HPV, putting them at risk of adverse pregnancy outcomes, secondary infertility or cervical cancer in a country with limited medical coverage. Screening and treating these women could be crucial in reducing morbidity.