STI prevalence, partner notification and HIV risk perception in a cohort of women completing STI screening as part of a safer conception study

Background: Integrating STI and pre-exposure prophylaxis (PrEP) care may optimize sexual and reproductive health. Methods: We nested an STI-sub-study within an HIV prevention cohort (Parent study) of 18- 35-year-old women from South Africa, planning pregnancy with a partner with HIV or of unknown-serostatus. Parent-study women completed annual surveys regarding HIV-risk perceptions and were offered oral PrEP. PrEP initiators completed quarterly plasma tenofovir testing. Sub-study women completed STI screening at enrollment, 6 months, onset of pregnancy, and in the third trimester via examination, vaginal swabs tested via PCR for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, and blood tested for Treponema pallidum. Follow-up was six months. Women with STIs were treated, offered partner notification (PN) cards, and surveyed regarding PN practices. We describe STI prevalence and incidence, and model factors associated with prevalent infection. STI sub-study and Parent-study-only participants were matched on age and number of days on study to assess HIV-risk perception scores between the two groups and the proportion with detectable tenofovir. Among 50 sub-study participants, 15 (30%) had prevalent STI. All 13 completing follow-up reported PN. Most did not prefer assisted PN. Mean HIV risk perception scores and proportion with detected plasma TFV were similar across groups. Conclusions: High STI prevalence supports the importance of laboratory screening to optimize sexual health for women planning pregnancy. Rates of self-reported PN are reassuring; low interest in assisted PN suggests the need for alternative approaches. Enhanced STI care did not affect HIV-risk perception or PrEP adherence, however both were relatively high in this cohort.