Background. Sexually transmitted infections (STIs) continue to be a significant public health problem especially among women of reproductive age in Africa. Methods. A total of 2236 women that had enrolled in the MDP301 vaginal microbicide trial were tested for the presence of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Treponema pallidum, and Trichomonas vaginalis (TV). Results. CT was identified as the most prevalent STI (11%) followed by TV (10%), NG, and Syphilis (3%). The highest prevalence of coinfection was reported between T. pallidum and TV (19.67%, ), followed by CT and TV (13.52%, ). Risk factors that were significantly associated with STI acquisition were women of 23 years of age or younger (HR: 1.50, 95% CI 1.17, 1.93), baseline STI with CT (HR: 1.77, 95% CI 1.32, 2.35), TV (HR: 1.58, 95% CI, 1.20, 2.10), and T. pallidum (HR: 5.13, 95% CI 3.65, 7.22), and a low education level (HR: 1.30, 95% CI 1.02, 1.66). Conclusion. Young women with lower education and a history of STIs are at high risk of multiple STIs. Prevention programs should consider target approach to STI prevention among young women. This trial is registered with ISRCTN64716212. 1. Introduction According to the World Health Organization (WHO) 2008 estimates, the total global number of new cases of four of the curable sexually transmitted infections (STIs), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (Syphilis), and Trichomonas vaginalis (TV), was nearly 500 million cases in adults aged 15 to 49 years (WHO) [1]. In Sub-Saharan Africa alone, 69 million cases of these STIs are reported annually [2]. STIs continue to be a significant public health problem with an increased burden on women of reproductive age [3, 4]. They have been associated with a wide spectrum of complications such as urethritis and epididymitis in men and cervicitis in women [5, 6]; thus the more ascending cervical infections may cause pelvic inflammatory disease and untimely tubal pathology, which increases the risk of ectopic pregnancy, tubal infertility, and chronic abdominal pain [7, 8]. According to the WHO and UNAIDS, STI control programmes have three objectives: to interrupt the transmission of STIs; to prevent the development of diseases, complications, and sequelae; and to reduce the transmission of HIV infection [9]. Treatment for STIs needs to be effective and administered as promptly as possible. The syndromic management approach allows for immediate treatment based on the presentation of signs and symptoms. In South Africa, STIs including human immunodeficiency
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