High-risk human papillomavirus and HBV, HCV, and T. pallidum association among women living with HIV in selected health facilities of Mekelle, Tigray, Northern Ethiopia

Background: Sexually transmitted infections (STIs) such as Treponema pallidum (T. pallidum), Hepatitis B and C viruses (HBV and HCV), and Human Papillomavirus (HPV) are significant global health threats. High-risk HPV (HR-HPV), particularly associated with various cancers, poses increased risks when other infections co-occur. However, there is limited data regarding the prevalence of HBV, HCV, and T. pallidum alongside high-risk HPV in women living with Human Immunodeficiency virus (HIV) in Ethiopia. This study focuses on exploring the association between these infections and HR-HPV in Mekelle, Tigray, Northern Ethiopia. Methods: A facility-based cross-sectional study was conducted from December 10, 2024, to July 10, 2025, in five governmental health facilities in Mekelle City (Special Zone), Tigray, Northern Ethiopia, among consecutively enrolled 390 women living with HIV. The study assessed the participants’ socio-demographic characteristics and infection markers for HBV, HCV, T. pallidum and HR-HPV. Data collection involved interviewer-administered questionnaires, the collection of venous blood, and cervical brush samples. Serologic testing for HCV, HBV, and T. pallidum was conducted using rapid test kits, while high-risk HPV DNA and HCV RNA were analyzed using Abbot Real-time PCR assays. Data analysis was executed using SPSS version 27, applying descriptive statistics and statistical tests, including Chi-square tests and logistic regression models, to evaluate the association between HCV, HBV, T. pallidum, and HR-HPV infections. Variables demonstrating significance at p < 0.05, with 95% confidence intervals not crossing “1,” progressed forward to multivariate analysis. Statistically significant associations were established at p < 0.05, along with their respective 95% confidence interval. Result: Majorities of the participants were urban dwellers, 88.5% (345/390), and the median age was 42 years (interquartile range = 14). The prevalence rates for various infections were reported as follows: HR-HPV at 39.7% (155/390), T. pallidum at 10.3% (28/390), HBV at 7.2% (40/390) and HCV at 1.5% (6/390). The collective positivity rate of HBV, HCV and T. pallidum was 34.19% (53/155) among HR-HPV positive women. Specific co-infection rates demonstrated 14.2% (22/155) for HBV-HR-HPV, 17.4% (27/155) for T. pallidum-HR-HPV, and 2.6% (4/155) for HCV-HR-HPV. When stratified by HR-HPV types, the highest percentage of co-infection was found between HPV-16-T. pallidum at 28.5% (12/42), and HPV-16-HBV at 23.8% (10/42). The odds of HR-HPV positivity were significantly higher among individuals with HBV (AOR = 6.52, 95% CI: 2.55–16.67, p < 0.001) and T. pallidum (AOR = 3.84, 95% CI: 1.89–7.79, p < 0.001). Conclusion: The study highlights significant associations between HR-HPV, HBV and T. pallidum among women living with HIV. These findings emphasize the necessity of integrated and regular screening for these sexually transmitted infections, as well as prompt treatment, counselling on safe sexual practices and partner tracing.