Sexually Transmitted Infections and Association with High-Risk Human Papillomavirus Among Ethiopian Women attending cervical cancer screening

Sexually Transmitted Infections and Association with High-Risk Human Papillomavirus Among Ethiopian Women attending cervical cancer screening | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sexually Transmitted Infections and Association with High-Risk Human Papillomavirus Among Ethiopian Women attending cervical cancer screening Habtamu Biazin, Selamawit Mekuria, Nahom Assegid, Ola Forslund, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5930727/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Sexually transmitted infections (STIs) continue to be a major public health concern and threat on a global scale. This study aimed to determine the prevalence and association of STIs coinfection with hrHPV and histological findings in a cohort of women attending cervical cancer screening with self-sampling. Method: This study was based on a cohort of 885 reproductive-aged women was attending cervical cancer screening at public prenatal care clinics in Adama, Ethiopia. The detection was performed by using the Allplex™ STI-EA real-time multiplex kit with the CFX96™ thermal cycler (Bio-Rad, CA, USA). The Seegene Anyplex II HPV HR test kit was used for the simultaneously detection of 14 hrHPV genotypes. Multivariable logistic regression analyses were made to test the association between the variables. Result: Of all the study participants, 568 (64.2%) had at least one sexually transmitted microorganism (95% CI: 61-67). The overall prevalence of: Neisseria gonorrhea (NG) was 0.6% (95% CI: 0.2-1.5), Chlamydia trachomatis (CT) 1.4% (95% CI: 0.7-2.3), Trichomonas vaginalis (TV) 2.6% (95% CI: 1.6-3.8), Mycoplasma genitalium (MG) 2.3% (95% CI: 1.4-3.5), Mycoplasma hominis (MH) 19% (95% CI: 16-22), Ureaplasma urealyticum (UU) 23.2% (95% CI: 20.5-26.1), and Ureaplasma parvum (UP) 46.6% (95% CI: 43-50). The prevalence of NG, CT, and TV infection was 4.2% (37). There was correlation between CT (adjusted odds ratio (AOR)=5.4, 95% CI=1.4-21, p=0.014), MH (AOR=2.0, 95% CI= 1.4-3.0, p=0.001), HIV status (AOR=3.6, 95% CI= 2.0-6.6, P<0.001) with high-risk HPV infection. Hr-HPV infection was independently associated with histological abnormalities (AOR=14.8, 95% CI:1.1-19.9, p=0.043). Conclusion: Our study revealed a high prevalence of UU and MH in one out of five and UP in almost half of asymptomatic Ethiopian women. The prevalence of TV, MG, CT, and NG was low. There was a link between CT, MH, and HIV status and high-risk HPV infection. A high-risk-human papillomavirus and HIV infection was independently linked with histological abnormalities. Ethiopia Human papillomavirus Multiplex RT-PCR Self-sampling sexually transmitted pathogens Figures Figure 1 Figure 2 Figure 3 Introduction Sexually transmitted infections (STIs) are a global public health issue, with over one million infections acquired daily, the majority without symptoms. It is estimated that 374 million people acquired one of the four treatable STIs (chlamydia, gonorrhea, syphilis, and trichomoniasis) annually, which can lead to complications such as preterm birth, ectopic pregnancy, and infertility (1,2) Mycoplasma genitalium (MG) is an emerging STI causing nongonococcal urethritis (NGU) in men and cervicitis in women, often occurring alongside other STIs, complicating its role in urogenital diseases. It is linked to preterm delivery, infertility, and pelvic inflammatory disease(PID) (3)(4). Ureaplasma species and Mycoplasma hominis (MH) are prevalent in the genital tracts of sexually active individuals, with varying prevalence based on sexual activity (5–9). But there is still a lack of study on their clinical relevance (6,9). PCR-based techniques, such as the Allplex™ STI Essential Assay, can help define the epidemiology of these infections by detecting multiple microorganisms simultaneously (10). Persistent high-risk HPV (hr-HPV) infection is a known cause of cervical intraepithelial neoplasia (CIN) and cervical cancer (11). Alongside hr-HPV, co-infections with other STIs, such as HIV and genital Chlamydia, have been frequently reported (12–19). In Ethiopia, data on STI co-infection with hr-HPV and their role in histological abnormalities is limited. This study aimed to assess the prevalence of specific STIs in asymptomatic, sexually active Ethiopian women and explore correlations with hr-HPV and histopathological findings. Materials and methods 2.1 Study area and study period A cohort of reproductive-aged women enrolled in two public prenatal care clinics in Adama, Ethiopia. Adama is one of the cities in the region and has a city administration consisting of 14 urban and four rural kebeles (the smallest unit of administration) with more than 340,000 inhabitants. The city has one referral hospital, three clinics, and more than ten health posts. 2.2 Study participants A cohort of 1200 childbearing reproductive women, aged 23-46 years were approached in the cohort. A cohort study was carried out among women participating in community-based cervical cancer screening in Adama, Ethiopia . A total of 885 women self-collected vaginal swab in the cohort and examined for hr-HPV genotypes and STIs using real-time polymerase chain reaction (RT-PCR) technique. Out of 187 vaginally hrHPV positive women, 116 underwent cervical histopathology testing. The period of sample collection was November 5, 2021, through June 16, 2023. 2.3 Sample collection, processing and storage 2.3.1 Sample collection Copan eNat® swab collection and Universal Transport Medium (Copan Italia SpA, Brescia, Italy) was used to collect and transport samples for molecular investigations. The sample was collected November, 2021 to July, 2022. The Copan eNat® medium is a commercially available guanidine thiocyanate-based molecular medium that stabilizes nucleic acids (DNA and RNA) at room temperature for over a month while degrading proteins and inactivating microbial infectivity via cell membrane lysis. The interaction of guanidine thiocyanate with detergents results in inactivation. The women were supported in collecting the sample by trained data collectors. The training for participants that comprised of a local language-translated presentation of the self-collection apparatus was carried out, and then sample collection took place in a separate room. Every two weeks, a batch of samples was transported from Adama to Addis Ababa University, Department of Microbiology, Immunology, and Parasitology, Molecular Laboratory to be processed and tested. 2.3.2 DNA extraction DNA was extracted from each cervicovaginal specimen (200 μl) using the StarMag 96 x4 Universal Cartridge Kit (Seegene, Seoul, republic of Korea) by using Seegene MICROLAB Nimbus (Hamilton, Reno, NV, USA) platform, a completely automated liquid handling workstation for nucleic acid extraction and polymerase chain reaction (PCR) setup of up to 72 specimens. DNA was eluted in 100ul elution buffer, according to the manufacturer’s instructions and stored at −20 ◦C until further use. 2.3.3 Detection of STIs Multiplex RT-PCR Allplex™ STI Essential Assay (Seegene, Seoul, Korea) was used for testing. The assay can detect seven sexual transmitted microorganisms(STMs) ( C. trachomatis, N. gonorrhoeae, T. vaginalis, M. genitalium, M. hominis, U. urealyticum, and U. parvum ) in a single tube using dual priming oligonucleotide (DPO™) and multiple detection temperatures (MuDT™), providing individual Ct values for multiple pathogens in one channel(20). As directed by the manufacturer, Anyplex™ STI-EA detection use 5 μl of template DNA and 15 ul of extracted nucleic acid in a total volume of 20 μl. Then, real-time PCR was done by using Allplex™ STI essential assay on the CFX96 Bio-Rad real-time thermocycler (Bio-Rad, CA, USA) in associated with the IVD Seegene software. The Real-time PCR was carried out in accordance with the manufacturer's instructions. The thermal cycle conditions consisted of an initial incubation at 50 for 4 min to activate the UDG system and prevent contamination, and pre-denaturation at 95 for 15 min, followed by 50 cycles of alternating incubations: 95 for 30s, 60 for 1 min, and 72 for 30s. An internal control (IC, human beta globulin) and positive control were run in each reaction(10). HIV status : HIV serostatus data was collected from the database of the cohort (21). HPV detection and typing : HPV detection and typing was performed using a commercial kit, Anyplex II HPV HR (Seegene, Korea), which can detect 14 hr HPV types (i.e., 16, 18, 31, 33, 35, 39, 45, 51,52, 56, 58, 59, 66, and 68) in a single reaction tube by means of real-time PCR assays on the CFX96 real-time PCR instrument (Bio-Rad, Hercules, CA, USA). 2.3.4 Histological samples: Histologic examination was done for 116 hr-HPV positive women. Cervical biopsy samples were collected and placed in screw-capped and labeled bottles containing 10% formol fixative solution before being sent to the pathology laboratory for processing. This cervical biopsy was used for histopathology testing using the standard staining method and evaluated by pathologists. Microscopic examination of the slides revealed the presence of benign alterations, low-grade squamous intraepithelial lesion (CIN1), high-grade squamous intraepithelial lesion (CIN2+), and invasive cervical cancer, as well as normal histology or no dysplasia was found. Finally, the potential relationships between the corresponding histological results and other STIs that are discovered concurrently with cervical HPV infection were determined. A pathologist stained and read the prepared slides, and the Lower Anogenital Squamous Terminology (LAST) report was used to classify them(22). . 2.4 Statistical analysis The data were recorded on REDCap and imported to IBM SPSS Statistics, Version 27.0 (Armonk, NY: IBM Corp.) for the statistical analysis. Tables and graphs were used to show the frequency, distribution, and prevalence of the seven sexually transmitted microorganisms. The participants of the study were stratified by age group (<25, 25-29, 30–34, 35-39, and ≥40 years) according to WHO health outcome studies (23), and we reported age-specific sexually transmitted microorganisms prevalence. Categorical variables were summarized using absolute frequencies and percentages. Chi-Square or Fisher`s exact test, and logistic regression analyses were conducted to identify factors related to sexually transmitted microorganisms, and association with dysplasia or cervical cancer. In the multivariable analysis, variables with a p-value of less than or equal to 0.2 from the bivariate analysis were taken into account. The association level was determined using an odds ratio with a 95% CI. Variables with p-values less than 5% were considered statistically significant associations between variables and sexually transmitted infections in the multivariable analysis. 2.5 Ethical consideration This study was approved by ethical review committees at Addis Ababa University, Department of Microbiology, Immunology, and Parasitology (DERC/04/2021), College Ethical Review Board (IRB) (054/21/DMIP), AHRI/ALERT Ethics Review Committee (AAERC) (PO/15/20), and National Ethical Research Review Committee (NERC) (Ref. No. RAS/14.2/8382/21). Before recruitment, each subject provided written informed consent. The STI results were communicated with healthcare providers at Adama Referral Hospital Medical College for further evaluation and treatment. Trial number of the cohort was (https://clinicaltrials.gov/ct2/show/NCT03305991). Results 3.1. Characteristics of the study population Our study population included 885 women ages ranging from 23 to 46 years, with an average age of 31.82±4.32 years. During the data-collecting period, 54 (6.1%) of the study participants reported having experienced signs and symptoms of STIs; of these, 77.8% (n=42) had tested positive for one of the targeted STMs. A correlation was found between the presence of the examined pathogens and the presence of any symptoms (p=0.03). Overall, 11.1%(n=98) of the study participants had a history of sexually transmitted infections (STIs) (Table 1) . Table 1. Characteristics of the study participants and frequency of sexually transmitted microorganisms (N=885) Variables Responses STM results P value Positive N (%) Total n (%) Age <25 34(66.5) 51(5.8) 0.54 25-29 142(66) 216(24.4) 30-34 244(61.8) 395(44.6) 35-39 111(64.5) 172(19.4) ≥40 37(72.5) 51(5.8) Marital status Married 550(64) 860(97.2) 0.41 *Others 18(72) 25(2.8) Occupation Daily laborer 79(63.2) 125 (14.1) 0.89 Permanent job 137(63.4) 216(24.2) Housewife 352(65) 544(61.5) Educational level Illiterate 54(70.1) 77(8.6) 0.99 <6 grades 71(62) 115(13) 6-12 grades 392(64) 608(68.7) Higher Education 51(60.1) 85(9.5) HIV status Positive 54(83.1) 65(7.3) 0.02 Negative 514(63) 820(92.7) History of STI infections Yes 59(60.2) 98(11.1) 0.47 No 505(64.1) 788(88.9) STI symptoms during the data collection** Yes 42(78) 54(6.1) 0.03 No 526(63) 831(93.9) Lower abdominal pain Yes 8(72.2) 11(1.2) 0.552 No 560(63.4) 874(98.8) Vaginal bleeding a Yes 2(40) 5(0.6) 0.049 No 566(64) 880(99) Vaginal discharge Yes 37(84) 44(5) 0.049 No 531(63) 841(95) Notes: *Others: divorced(n=3)/windowed(n=2)/ single(n=20); ** had more than one STI symptoms; a, Fishers exact test, HIV; human immunodeficiency virus; STM, sexually transmitted microorganisms 3.2 Prevalence pathogens tested among the study population The overall prevalence of STPs were 64.2% (95% CI:60-67%). The prevalence of NG, CT, and TV were 0.6% (95% CI:0.2- 1.5%,), 1.4% (95% CI:0.7-2.3%), and 2.6% (95% CI:1.6-3.8%), respectively. The magnitude of the NG, CT, and/or TV combined were 4.2% (95% CI:3.0-5.7). The prevalence of MG, MH, UU, and UP were 2.3% (95% CI:0.7-2.3%), 19% (95% CI:16.9-22.2), 23.2(95% CI:20.5-21.1), and 46.6% (95% CI:41-50), respectively (Figure 1) . The rate of mycoplasmas and ureaplasmas species detection was (MG, MH, UU, and UP) 566 (64%, not shown in the figure). Sexually transmitted microorganisms (STMs) prevalence was 83% (54) in women with HIV and 63% (514) in women without HIV (p=0.002). STMs was more frequent among women with HIV than without HIV with odds ratio of 2.7 (95% CI: 1.4-5.4, p=0.02). The prevalence of NG, CT, TV and MG among women live with HIV was 3.2, 3.2, 6.5 and 1.6%, respectively. The prevalence of the NG/CT/TV among women living with HIV was 9.1% (6) versus 3.8% (31) among women without HIV. The rate of NG (p=0.046), CT (p=0.23), and TV (p=0.22) was higher among HIV positive women compared to HIV negative women. The odds of getting NG/CT/TV infections in HIV positive women was 2.8 (95% CI: 1.5-8.2, p=0.02) (Table 2). Table 2: The prevalence of Sexually transmitted Microorganisms (STMs) among women lives with HIV and without HIV STI status HIV status n (%) ** OR 95% CI P value Positive (n=65) Negative (n=820) Total STMs detected 54(83) 514(62.8) 2.7(1.4-5.4) 0.002 NG 2(3.1) 3(0.4) 9.1(1.5-55.6) 0.046* CT 2(3.1) 10(1.2) 2.7(0.6-12.6) 0.23* MG 1(1.5) 19(2.3) 0.7(0.1-5.3) 1.00* TV 4(4.6) 19(2.3) 2.0(0.6-7) 0.22* NG/CT/TV 8(12.9) 47(5.7) 2.8(1.5-8.2) 0.02 MH 23(35.4) 143(17.4) 2.6(1.5-4.4) <0.001 UU 26(40) 180(22) 2.4(1.4-4.0) <0.001 UP 34(52.3) 378(46.1) 1.3(0.8.2.1) 0.33 Single infection 27(41.5) 335(40.8) 2.2(1.1-4.6) 0.024 Multiple infection 27(41.5) 179(22) 4.2(2-8.7) <0.001 *Fisher exact test was used, ** proportions calculated in a column, CT: Chlamydia trachomatis; NG: Neisseria gonorrhoeae; TV; Trichomonas vaginalis; MG: Mycoplasma genitalium; MH: Mycoplasma hominis; UU: Ureaplasma urealyticum; UP: Ureaplasma parvum, OR; Odds Ratio, STMs, sexually transmitted microorganisms 3.3 Age specific prevalence of NG, CT, TV, MG, MH, UU, and UP The frequency of infection in each age group of women was 67%, 65%, 61%, 64%, and 73%, respectively . The age group of ≥ 40 years had the highest detection rate 73%(37/51), followed by the age groups of <25 67%(34/51), and 25-29 66%(142/216). NG, MG, and UU were more prevalent in women aged 25-29, and <25 compared to other age groups. The prevalance of UU decline over the age groups though the differences were not statistically significant (Figure 2) . 3.4 Co‐infection of rate of detected pathogens The frequency of single infections and co-infection among detected microorganisms were 41%(n=362) and 23% (n=206), respectively. The highest frequency of co-infection was reported between MH, and UP, occurred 17.2% (97/568), followed by MH and UU with 15.5% (88/568) for each. NG, CT, MG, and TV had common co-occurrence with UP, MH, UU, and MH, respectively (Table 3 ). Table 3 : The distribution of co-infection among multiple Microorganisms detected Microorganisms Co-infection pathogens n (%) Total NG CT MG TV MH UU UP NG NA 0 1(10) 1(10) 2(20) 2(20) 4(40) 10 CT 0 NA 1(5.3) 1(5.3) 7(37) 6(32) 4(21) 19 MG 1(6.7) 1(6.7) NA 2(13.3) 2(13.3) 5(33.3) 4(27) 15 TV 1(2.2) 1(2.2) 2(4.4) NA 14(30.4) 11(24) 7(15) 46 MH 2(1) 7(3.3) 2(1) 14(7) NA 88(42) 97(46.2) 210 UU 2(1.1) 6(3.2) 5(2.7) 11(6) 88(47) NA 70(37) 187 UP 4(2.2) 4(2.2) 4(2.2) 7(3.8) 97(52.2) 70(37.6) NA 186 CT: Chlamydia trachomatis; NG: Neisseria gonorrhoeae; TV; Trichomonas vaginalis; MG: Mycoplasma genitalium; MH: Mycoplasma hominis; UU: Ureaplasma urealyticum; UP: Ureaplasma parvum; NA= Not applicable Age specific incidence of co-infections with two or more sexually transmitted microorganisms was picked age group <25 years, followed by age 30-34 years and declined after wards . Additionally, the age distribution and co-infection rates varied depending on the pathogen type. Furthermore, the frequencies of co-infection and age distribution varied according to pathogen type. Single infections were more common among women aged 40 or older (Figure 3). 3.5 Hr-HPV co-infection with other STMs The co-infection rate of HPV/STMs was 23% (141/614) among hr-HPV and/or STM positive cases. U. parvum was the most frequently detected pathobiont with 51%, followed by UU in 32%, MH in 31%, TV in 4%, MG in 3.5%, and TV in 2.5% respectively among hr-HPV-positive women. The co-infection rate of HPV/NG was 0.5% (1/191), HPV/CT was 4.2% (8/191), HPV/MG was 3.5% (7/200), HPV/TV was 1.9% (4/206), HPV/MH was 19.7% (58/295), HPV/UU was 18.1% (60/333), and HPV/UP was 16.8% (95/504) (not shown in the table). The positive rate of high-risk HPV infection was 1.4 times higher in the STMs positive group compared to STMs negative group (AOR=1.4, 95%CI: (0.8-2.7), P=0.26). In the multivariate logistic regression analysis, C. trachomatis (AOR: 5.4,95% CI: 1.4-21, P=0.014), M. hominis (AOR:2.0, 95%CI: 1.4-3.0, P=0.001 ) , and HIV (AOR:3.6,95% CI: 2.0-6.6, P<0.001) remained the significant associated factors for hrHPV infection (Table 4). Table 4: Association of sexually transmitted microorganisms, and hr-HPV infection with bivariate and multivariate logistic regression STI status Response N Hr-HPV status n (%) COR 95% CI P value AOR 95%CI P value Positive (N=187) Negative (N=698) Total STMs Positive 568 141(26.4) 427(73.6) 2(1.3-2.8) <0.001 1.4(0.8-2.7) 0.26 Negative 317 46(15.5) 271(84.5) 1 1 NG Positive 5 1(20) 4(80) 0.9(0.1-8.4) 1.00 0.7(0.1-7) 0.75 Negative 880 186(21.5) 694(78.5) 1 1 CT Positive 12 8(66.7) 4(33) 7.8(2.3-26) <0.001 5.4(1.4-21) 0.014 Negative 873 179(20.5) 694(79.5) 1 1 MG Positive 20 7(35) 13(65) 2(.8-5.2) 0.16 1.5(0.5-4) 0.60 Negative 865 180(20.8) 685(79.9) 1 1 TV Positive 23 4(17.4) 19(82.6) .8(.3-2.5) 0.80 0.6(0.2-1.9) 0.42 Negative 862 183(21.2) 679(78.8) 1 MH Positive 166 58(34.9) 108(65.1) 2.5(1.7-3.7) <.001 2.0(1.4-3.0) 0.001 Negative 719 129(17.9) 590(82.1) 1 UU Positive 206 60(29.1) 146(70.9) 1.8(1.3-2.6) 0.001 1.5(0.9-2.1) 0.053 Negative 679 127(18.7) 552(81.3) 1 UP Positive 412 95(23.1) 317(76.9) 1.2(0.9-1.7) 0.19 1.2(0.5-2.0) 0.99 Negative 473 92(20.5) 381(80.5) 1 1 HIV status Positive 65 30(46.2) 35(53.8) 3.6(2.2-6.1) 0.001 3.2(1.8-5.5) <0.001 Negative 820 157(19.1) 663(79.9) 1 1 Number of STMs Single 362 75(20.7) 287(79.3) 1 1 0.80 Multiple 206 66(32) 140(68) 1.8(1.2-2.6) 0.002 1.1(0.5-3) Note: STM, sexually transmitted microorganisms, hr-HPV, high-risk human papillomavirus, CI, confidence interval; COR, crude odds ratio; AOR, adjusted odds ratio; CT: Chlamydia trachomatis; NG: Neisseria gonorrhoeae; TV; Trichomonas vaginalis; MG: Mycoplasma genitalium; MH: Mycoplasma hominis; UU: Ureaplasma urealyticum; UP: Ureaplasma parvum. 3.6 Association of STMs, and hrHPV with histological findings Of the 116 histology specimens, 52(45%) was hr-HPV positive, 84(72.4%) were positive for sexually transmitted microorganisms (STMs), 3(2.6%) women were diagnosed with CIN1, 6(5.2%) showed CIN2/3, and 2(1.7%) had invasive cervical cancers. A significant relationship was found between abnormal cervical histology findings and hr-HPV infection (AOR)=22, (95% CI:1.6-308, p=0.02 ). A significant association was found between HIV and CIN2+ or cervical cancer (AOR: 19, (95%CI :1.8-206, p=0.015) ( Table 5). Table 5: The association between histopathological results with hr-HPV, and detected sexually transmitted microorganisms (n=116) Infection status Histological Grades n (%) Total CIN2+* ≤CIN1 COR 95% CI P-Value AOR 95% CI P-Value Hr-HPV§ + 52 6(11.5) 46(84.6) 7.8(.9-67) 0.061 22(1.6-308) 0.02 - 61 1(1.6) 60(96.7) 1 1 HIV status + 22 5(22.7) 17(77.3) 8.9(1.9-41) 0.005 19(1.8-206) 0.015 - 94 3(3.2) 91(96.8) 1 1 Overall STMs + 84 6(7.1) 78(92.9) 1.2(0.2-6.0) 0.87 1.2(0.2-4) 0.34 - 32 2(6.3) 30(93.7) 1 1 NG + 1 0(0) 1(100) 0 1.00 - 0.98 - 115 8(7.0) 107(93) 1 1 CT + 5 1(20) 4(80) 3.7(0.4-38) 0.27 1.7(0.03-84) 0.80 - 111 7(6.3) 104(93.7) 1 1 MG + 4 0(0) 4(100) 0 1.00 - 0.99 - 112 8(7.1) 104(92.9) 1 1 TV + 4 1(25) 3(75) 5(0.5-54) 0.19 3.1(0.2-30) 0.56 - 112 7(6.3) 105(93.7) 1 1 MH + 43 5(11.6) 38(88.7) 3.1(0.7-14) 0.14 3.5(0.5-18) 0.21 - 73 3(4.1) 70(96) 1 1 UU + 38 5(13.2) 33(86.8) 1.3(0.3-5.5) 0.77 2.4(0.3-12.7) 0.43 - 78 5(6.4) 73(93.6) 1 1 UP + 56 1(1.8) 55(98.2) 0.14(0.16-1.56) 0.068 0.01(0.2-2.3) 0.50 - 60 7(11.7) 53(83.3) 1 1 Type of STMs Multiple 44 7(16) 37(84) 7.4(0.7-18.4) 0.15 14(0.5-39.8) 0.12 Single 40 1(2.5) 39(97.5) 1 1 Coinfection ** HPV - /STI - 16 1(6.25) 15(93.75) 1 HPV only 16 1(6.25) 15(93.75) 2.3(0.25-21.8) 0.455 - STI only 47 1(2.1) 46(97.8) 2.3(0.25-21.8) 0.455 - HPV/STI+ 37 5(13.5) 32(86.5) 7.2(0.8-64.4) 0.078 - Note: HPV, Human Papillomavirus; CIN, cervical intraepithelial neoplasia; * CIN2+ includes, CIN2,3 and invasive cervical cancers; STMs, sexually transmitted microorganisms; + positive, - negative, § three sample were invalid (1 from CIN2+ and two were from ≤CIN1), **multiple regression adjusted for multicollinearity. Discussion 4.1. Main conclusions and implications of this study The overall STI prevalence in our study was relatively high (64%). Our finding was higher compared with other studies in Ethiopia which found rates ranging from 14.3-26.6% (24–26). It was lower than rates found from South Africa (84%) and Ghana (77%) using the same detection methods (27,28). These variations can be explained by differences in study populations, detection techniques, and the number of infectious agents studied. Most other studies focused on pregnant women and sex workers at clinics(29). The high rate of genital infection in our study of asymptomatic women highlights the need for increased awareness among health workers. 4.2 NG and CT in this study and others, why they are differed, and implication for treatment The infection rate of NG (0.6%), and CT (1.4%) was low in our study. The prevalence of NG in our study was in agreement with the study conducted in Hawassa , Ethiopia (0.7%) by endocervical swabs(30), and Italy (0.4%) by vaginal swab(31). However, lower than the study conducted in Adama, Ethiopia , and in Jimma, Ethiopia with reported value of 3.8% and 9.8% among clinically suspected cases with cervical swabs (32,33), respectively. This variation was attributed to several factors, including differences in study populations, geographical locations, methods of sample collection, and detection methods. For instance, variations in sexual behavior, underlined conditions like HIV, socioeconomic status, and access to healthcare can influence prevalence rates. Additionally, differences in diagnostic techniques and the criteria for selecting study participants may also account for the discrepancies observed. Our findings are similarly consistent with Kenya, where vaginal swab prevalence is reported to be 7.5%(34). Etiological testing that was predicated on STI symptoms and signs or individuals with gynecological complaints may account for these variances. In addition to that the detection methods and the nature of the study group may attribute for these variations. For instance, in our context we included more younger age groups and the HIV prevalence in the town was 2.4% (0.6-6.7%)(35). NG may cause PID in women, epididymitis in men, and neonatal complications why it should be treated even in asymptomatic women. According to current treatment guidelines ceftriaxone is recommended and if CT co-infection doxycycline is used. Patients should be retested three months post-treatment to monitor for reinfection, and sexual partners should also be informed and treated to prevent further transmission. Due to rising antibiotic resistance, healthcare providers must monitor treatment outcomes and report failures to aid in updating treatment protocols(36,37). The prevalence of CT in our study was in agreement with the study conducted in a cohort of 215 reproductive women in Chad with the same detected method(38). Another report in Italy showed that 4.4% of CT prevalence with the same detection and sampling methods(39). CT may cause serious complications if untreated, including PID, ectopic pregnancy, infertility, epididymitis, reactive arthritis (Reiter’s syndrome) or neonatal conjunctivitis or pneumonia, and increased HIV risk. Treatment typically involves doxycycline or, if contraindicated, azithromycin or levofloxacin, with azithromycin preferred during pregnancy. Retesting is recommended three months post-treatment due to high reinfection rates, and partners should be informed and treated to prevent further transmission(37). 4.3 TV in this study and others, why they are differed, and implication for treatment The infection rate of TV (2.6%) was low in our study. In African populations studies, the estimated prevalence of vaginal TV infection was 11-25% which was significantly higher than in our finding(40). Our prevalence was higher than reports in Italy 1.7% (39) and in Chad 0.4% with the same sampling and detection methods(38). TV causes vaginitis in women, urethritis and prostatitis in men, increased HIV risk, and pregnancy complications such as preterm delivery, low birth weight, and increased risk of neonatal infections. The treatment recommended is metronidazole or tinidazole as first-line with retesting after three months due to high reinfection rates. Sexual partners should be informed, tested, and treated to prevent reinfection, and STI screenings are essential for further prevention(37). 4.4 MG in this study and others, why they are differed, and implication for treatment Mycoplasma genitalium was identified in 2.3% of women in our study. There are significant regional variations in the prevalence of MG infections. Studies from Western Europe, North America, and Australia has estimated that the prevalence of MG varies from 1% to 3.3% in men and from 1% to 6.4% in women(41,42). Our results were consistent with the 2.3% prevalence rates of MG infection reported in an Iranian systematic review and metanalysis (43).However, a study carried out 612 cohort of younger women in Portugal with the same sampling and detection method as ours revealed lower (0.8%) prevalence for MG (44). 4.5 MH, UU, and UP in this study and others, and implication for treatment The prevalence of MH (19%), UU (23%), and UP (47%) in the present study. The colonization rates of MH, UU, and UP are significantly higher in the genital tracts of adults, with 30-80% of healthy adult women and 15-30% of healthy adult men harboring Ureaplasma spp. Sexually active adolescents and abused girls are more likely to carry MH and UU/UP than non-sexually active girls(6,7,45). Our findings were in line with the prevalence rates of female genital infections with MH 20%, UU 19%, and UP 45%, according to a systematic review and metanalysis conducted in Iran(43). However, another study carried out 612 cohort of younger women in Portugal with the same sampling and detection method as ours revealed lower prevalence for MH (8.5%), and UP (22.4%), except UU (28.4%) which was comparable with our finding (44). Discovering infections caused MG, MH, UU/UP is crucial due to their potential impact on reproductive and sexual health, as well as their role in coinfections. These organisms can cause bacterial vaginosis (BV), pelvic inflammatory disease (PID), urethritis (non-gonococcal and no chlamydial), vaginitis, and adverse pregnancy outcomes like preterm birth and premature membrane rapture(37). Symptomatic infections should be treated to prevent significant discomfort and complications, while treatment for asymptomatic infections is often recommended for pregnant women and high-risk populations. Some infections resolve spontaneously, but monitoring is essential to prevent complications and ensure treatment if symptoms develop(46). Asymptomatic individuals frequently have Mycoplasma and Ureaplasma species detected, indicating colonization rather than active infection(47). Individual risk factors, transmission potential, and the possibility of complications should all be considered when making a treatment decision(48). Co-infections with mycoplasma and other STIs were prevalent in our study. There have been numerous reports of mycoplasma and other STI co-infections(49–52). In order to select the most effective treatment or treatments and minimize repeat visits, healthcare practitioners should take into account testing women for other genital infections, in addition to CT and NG. It is important to take into account that because of STIs overlapping risk factors and routes of transmission, it is a real possibility co-occurrence of STIs (53). It has been shown in recent research that some STIs might affect how other STI infections develop, either accelerating the course of the illness or changing immune responses(54). There are evidences linking CT and NG coinfection to higher rates of treatment failure and antibiotic resistance(55). 4.6 Association between hrHPV and NG, CT, MG, MH, UU, and UP C. trichomatis, M. hominis , and HIV remained the significant risk factors for hrHPV infection in our study. An epidemiological study in Greece found a link between hr-HPV infection and Ureaplasma species, while studies in China and Mexico found no correlation between hr-HPV and CT, TV, or UU (19,56,57). Studies in Brazil associated C. trachomatis with high-grade neoplasia in women with HPV; however, an Indian report contradicted this finding about CT(58,59). STIs act as HPV cofactors by causing chronic cervical inflammation and ulceration and by reducing host cell-mediated immunity via their role as HPV cofactors. Infection by high-risk HPV types is crucial to the pathogenesis of invasive cervical cancer (ICC), but other cofactors must be present for the development of malignancy(60). CT biological effect may damage the mucosal barrier, improving HPV infection, or may interfere in immune response and viral clearance supporting the persistence of HPV infection. Moreover, CT-related chronic cervical inflammation, decrease of lower genital tract antigen-presenting cells, inhibition of cell-mediated immunity, and anti-apoptotic capacity may influence the natural history of HPV infection, namely persistence progression or resolution(60). No correlation was found between abnormal cervical histology and total sexually transmitted microorganisms (STMs) detection in our study. Previous studies supported this finding, showing no correlation between cervical histology and STMs (15,61). However, larger studies have linked common urogenital infections with cervical neoplasia and cervical cancer, emphasizing the importance of STI screening in women with hrHPV (62). 4.7 Strengths and limitations This study's main strength is primarily the large patient sample, with 885 patients involved in the research. We conducted the first community-based study of its kind to address pathobionts (UP, UU, and MH) in Ethiopia. Additionally, to minimize variability, molecular assessments (for both HPV and other STMs) have been carried out in a single laboratory affiliated with a university, using cutting-edge molecular assays with robust automated extraction technique. The main limitation of this, we did not examine the presence of pathogens like herpes simplex virus (HSVs), conditions like bacterial vaginosis or vaginal Candidiasis that may have an additional role either as true pathogens, facilitators, or commensals. Other limitation of the study was, the biopsy results were not guided by colposcopy. Summary Our study revealed a high prevalence of Ureaplasma urealyticum, and Mycoplasma hominis in one out of five and Ureaplasma parvum in almost half of asymptomatic Ethiopian women. In contrast, the prevalence of Trichomonas vaginalis (3%), Mycoplasma genitalium (2%), Chlamydia trachomatis (1%), and Neisseria gonorrhoeae (less than 1%) was low among asymptomatic Ethiopian women. These findings support the importance of thorough testing with sensitive technologies to avoid unnecessary antibiotic use and guide improvements in Ethiopia’s reproductive healthcare system. Larger studies in symptomatic women are recommended. Abbreviations AOR Adjusted odds ratio CI Confidence interval CIN Cervical Intraepithelial Neoplasia CIN2+ Cervical Intraepithelial Neoplasia 2 and worse COR Crude odds ratio CT Chlamydia trachomatis Hr-HPV High-risk Human Papillomavirus MG Mycoplasma genitalium MH Mycoplasma hominis NG Neisseria gonorrhoeae NILM Negative for Intraepithelial Lesion Malignancy OR Odds ratio PID Pelvic inflammatory disease STD/Is Sexually transmitted diseases/Infections STPs Sexually transmitted pathogens STMs Sexually transmitted microorganisms TV Trichomonas vaginalis UP Ureaplasma parvum UU Ureaplasma urealyticum Declarations Ethics approval and consent to participate This study was approved by ethical review committees at Addis Ababa University, the Department of Microbiology, Immunology, and Parasitology (DERC/04/2021), the College Ethical Review Board (IRB) (054/21/DMIP), the AHRI/ALERT Ethics Review Committee (AAERC) (PO/15/20), and the National Ethical Research Review Committee (NERC) (Ref. No. RAS/14.2/8382/21). Before recruitment, each subject provided written informed consent. The HPV and STI results were communicated with healthcare providers at Adama Referral Hospital Medical College for further evaluation and treatment. ClinicalTrials.gov ID: NCT05125380. Availability of data and material: The data that support the findings of this study are available from the corresponding author upon reasonable request Consent for publication: Not applicable Financial disclosure: All authors declare that they have no competing financial interests. Conflicts of interest: All authors declare that they have no competing interests. Acknowledgments: The authors would like to acknowledge all the collaborators of this work, Lund University, Addis Ababa University, and Armauer Hansen Research Institute and Addis Ababa University Vice President Research for Research and Technology. Authors contribution HB, and SM research concept and design; HB, NA, and SM – collection and/or assembly of data; HB-Laboratory work and result interpretation; data analysis and interpretation; drafting and writing the manuscript; OF, CB, TA, AD, and MJ – critical revision of the manuscript and final approval of article. References World Health Organization. Global Health Sector Strategy on Sexually Transmitted Infections 2016–2021 Implementation Framework for the African Region. WHO Reg Off Africa [Internet]. 2018;1–30. Available from: https://www.afro.who.int/sites/default/files/2019-03/STI.EN_.pdf World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Who [Internet]. 2021;53(9):1689–99. Available from: https://www.who.int/publications/i/item/9789240027077 Munoz JL, Goje OJ. Mycoplasma genitalium : An Emerging Sexually Transmitted Infection. Scientifica (Cairo) [Internet]. 2016;2016:1–5. Available from: http://www.hindawi.com/journals/scientifica/2016/7537318/ Zhang XH, Zhao PZ, Ke WJ, Wang LY, Tso LS, Chen ZY, et al. Prevalence and correlates of Mycoplasma genitalium infection among patients attending a sexually transmitted infection clinic in Guangdong, China: a cross-sectional study. BMC Infect Dis. 2021;21(1):4–11. Plummer EL, Vodstrcil LA, Bodiyabadu K, Murray GL, Doyle M, Latimer RL, et al. Are Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum Associated with Specific Genital Symptoms and Clinical Signs in Nonpregnant Women? Clin Infect Dis. 2021;73(4):659–68. Paralanov V, Lu J, Duffy LB, Crabb DM, Shrivastava S, Methé BA, et al. Comparative genome analysis of 19 Ureaplasma urealyticum and Ureaplasma parvum strains. BMC Microbiol. 2012;12. Song T, Ye A, Xie X, Huang J, Ruan Z, Kong Y, et al. Epidemiological investigation and antimicrobial susceptibility analysis of ureaplasma species and Mycoplasma hominis in outpatients with genital manifestations. J Clin Pathol [Internet]. 2014 Sep;67(9):817–20. Available from: http://jcp.bmj.com/lookup/doi/10.1136/jclinpath-2014-202248 Taylor-Robinson D. Mollicutes in vaginal microbiology: Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum and Mycoplasma genitalium. Res Microbiol [Internet]. 2017;168(9–10):875–81. Available from: http://dx.doi.org/10.1016/j.resmic.2017.02.009 McCormack WM, Almeida PC, Bailey PE, Grady EM, Lee YH. Sexual Activity and Vaginal Colonization with Genital Mycoplasmas. JAMA J Am Med Assoc. 1972;221(12):1375–7. Choe HS, Lee DS, Lee SJ, Hong SH, Park DC, Lee MK, et al. Performance of Anyplex TM II multiplex real-time PCR for the diagnosis of seven sexually transmitted infections: Comparison with currently available methods. Int J Infect Dis. 2013;17(12):1134–40. Zur Hausen H. Papillomaviruses in human cancers. Proc Assoc Am Physicians. 1999;111(6):581–7. Parthenis C, Panagopoulos P, Margari N, Kottaridi C, Spathis A, Pouliakis A, et al. The association between sexually transmitted infections, human papillomavirus, and cervical cytology abnormalities among women in Greece. Int J Infect Dis [Internet]. 2018;73:72–7. Available from: https://doi.org/10.1016/j.ijid.2018.06.001 Pouryasin M, Mousavi AS, Pakravesh J, Kamel DZ, Nooriardabili S, Khodadad S, et al. The Prevalence of HPV and non-HPV STIs Among Iranian Women and Assessment of the HPV/non-HPV STIs Co-infection on Cervical Cell Changes. J Obstet Gynecol Cancer Res. 2022;7(5):405–14. Martinelli M, Musumeci R, Sechi I, Sotgiu G, Piana A, Perdoni F, et al. Prevalence of human papillomavirus (HPV) and other sexually transmitted infections (STIS) among italian women referred for a colposcopy. Int J Environ Res Public Health. 2019;16(24). Alotaibi HJ, Almajhdi FN, Alsaleh AN, Obeid DA, Khayat HH, Al-Muammer TA, et al. Association of sexually transmitted infections and human papillomavirus co-infection with abnormal cervical cytology among women in Saudi Arabia. Saudi J Biol Sci [Internet]. 2020;27(6):1587–95. Available from: https://doi.org/10.1016/j.sjbs.2020.03.021 Valasoulis G, Pouliakis A, Michail G, Magaliou I, Parthenis C, Margari N, et al. Cervical HPV Infections, Sexually Transmitted Bacterial Pathogens and Cytology Findings&#x2014;A Molecular Epidemiology Study. Pathogens. 2023;12(11). Hong SR, Kim TJ, Lee IH, Kim HS. Relationships of Sexually Transmitted Infections, Bacterial (STI) with High-Risk Human Papillomavirus (HR-HPV) and Abnormal Cervical Cytology in Gynecological Outpatients. J Am Soc Cytopathol [Internet]. 2015;4(6):S34. Available from: http://dx.doi.org/10.1016/j.jasc.2015.09.080 Li W, Liu LL, Luo ZZ, Han CY, Wu QH, Zhang L, et al. Associations of sexually transmitted infections and bacterial vaginosis with abnormal cervical cytology: A cross-sectional survey with 9090 community women in China. PLoS One [Internet]. 2020;15(3):1–12. Available from: http://dx.doi.org/10.1371/journal.pone.0230712 Choi SH, Jin H, Lee KE. Prevalence of Sexually Transmitted Pathogen Coinfections in High Risk-Human Papillomaviruses Infected Women in Busan. Biomed Sci Lett. 2019;25(4):390–7. Chun JY, Kim KJ, Hwang IT, Kim YJ, Lee DH, Lee IK, et al. Dual priming oligonucleotide system for the multiplex detection of respiratory viruses and SNP genotyping of CYP2C19 gene. Nucleic Acids Res. 2007;35(6):6–11. Walles JK, Tesfaye F, Jansson M, Balcha TT, Winqvist N, Kefeni M, et al. Performance of QuantiFERON-TB gold plus for detection of latent tuberculosis infection in pregnant women living in a tuberculosis- and HIV-endemic setting. PLoS One. 2018;13(4):1–15. Darragh TM, Colgan TJ, Thomas Cox J, Heller DS, Henry MR, Luff RD, et al. The Lower Anogenital Squamous Terminology Standardization Project for HPV-associated Lesions. Int J Gynecol Pathol [Internet]. 2013 Jan;32(1):76–115. Available from: http://journals.lww.com/00004347-201301000-00012 Bray F, Ferlay J. Chapter 7 : Age standardization. 1954;0–3. Kassie BA, Yenus H, Berhe R, Kassahun EA. Prevalence of sexually transmitted infections and associated factors among the University of Gondar students, Northwest Ethiopia: A cross-sectional study. Reprod Health. 2019;16(1):1–8. Tamrat R, Kasa T, Sahilemariam Z, Gashaw M. Prevalence and Factors Associated with Sexually Transmitted Infections among Jimma University Students, Southwest Ethiopia. Int J Microbiol. 2020;2020. Schönfeld A, Feldt T, Tufa TB, Orth HM, Fuchs A, Mesfun MG, et al. Prevalence and impact of sexually transmitted infections in pregnant women in central Ethiopia. Int J STD AIDS. 2018;29(3):251–8. Moodley C, Tootla H, Amien I, Engel ME. Evaluating the utility of the Allplex STI Essential Assay to determine the occurrence of urogenital sexually transmitted infections among symptomatic and asymptomatic patients in Cape Town, South Africa. Bruisten SM, editor. PLoS One [Internet]. 2023 Nov 29;18(11):e0292534. Available from: https://dx.plos.org/10.1371/journal.pone.0292534 Sylverken AA, Owusu-Dabo E, Yar DD, Salifu SP, Awua-Boateng NY, Amuasi JH, et al. Bacterial etiology of sexually transmitted infections at a STI clinic in Ghana; use of multiplex real time PCR. Ghana Med J. 2016;50(3):142–8. Anbesu EW, Aychiluhm SB, Alemayehu M, Asgedom DK, Kifle ME. A systematic review and meta-analysis of sexually transmitted infection prevention practices among Ethiopian young people. SAGE Open Med. 2023;11. Tadesse E, Teshome M, Amsalu A, Shimelis T. Genital Chlamydia trachomatis Infection among Women of Reproductive Age Attending the Gynecology Clinic of Hawassa University Referral Hospital , Southern. 2016;1–11. Leli C, Mencacci A, Agnese M, Clerici P, Rassu M, Perito S, et al. Prevalence of cervical colonization by Ureaplasma parvum , Ureaplasma urealyticum , Mycoplasma hominis and Mycoplasma genitalium in childbearing age women by a commercially available multiplex real-time PCR : An Italian observational multicentre study. J Microbiol Immunol Infect. 2018;51(2):220–5. Tadse Grenfes and DG. Neisseria gonorrhoeae and their Antimicrobial Susceptibility Patterns among Patients from Adama Town, Ethiopia. :1–4. Sahile A, Teshager L, Fekadie M, Gashaw M. Prevalence and Antimicrobial Susceptibility Patterns of Neisseria gonorrhoeae among Suspected Patients Attending Private Clinics in Jimma , Ethiopia. 2020;2020. Oladokun A. Prevalence of genital Chlamydia trachomatis among women of reproductive age attending outpatient clinic at Kisumu County Referral Hospital, Kenya, 2021. 2022;13(3):1–9. Ethiopian Public Health Institute. HIV Related Estimates and Projections in Ethiopia for the Year 2021-2022 August 2022 Addis Ababa. Gmf [Internet]. 2023;(May):1–32. Available from: https://ephi.gov.et/wp-content/uploads/2021/02/HIV-Estimates-and-projection-for-the-year-2022-and-2023.pdf Nguyen PTT, Pham HV, Van DH, Pham L Van, Nguyen HT, Nguyen H Van. Randomized controlled trial of the relative efficacy of high-dose intravenous ceftriaxone and oral cefixime combined with doxycycline for the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae co-infection. BMC Infect Dis [Internet]. 2022;22(1):1–9. Available from: https://doi.org/10.1186/s12879-022-07595-w Hazra A, Collison MW, Davis AM. CDC Sexually Transmitted Infections Treatment Guidelines, 2021. JAMA [Internet]. 2022 Mar 1;327(9):870. Available from: https://jamanetwork.com/journals/jama/fullarticle/2789560 Compain F, Nodjikouambaye ZA, Sadjoli D, Moussa AM, Adawaye C, Bouassa R-SM, et al. Low Prevalence of Common Sexually Transmitted Infections Contrasting with High Prevalence of Mycoplasma Asymptomatic Genital Carriage: A Community-Based Cross-Sectional Survey in Adult Women Living in N’Djamena, Chad. Open Microbiol J. 2019;13(1):222–9. Bianchi S, Frati ER, Canuti M, Colzani D, Fasoli E, Amendola A, et al. Molecular epidemiology and genotyping of Chlamydia trachomatis infection in a cohort of young asymptomatic sexually active women (18-25 years) in Milan, Italy. J Prev Med Hyg. 2016;57(3):E128–34. Mabaso N, Abbai NS. A review on Trichomonas vaginalis infections in women from Africa. South African J Infect Dis. 2021;36(1):1–9. Salado-Rasmussen K, Jensen JS. Mycoplasma genitalium testing pattern and macrolide resistance: A Danish nationwide retrospective survey. Clin Infect Dis. 2014;59(1):24–30. Jensen JS, Cusini M, Gomberg M, Moi H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatology Venereol. 2016;30(10):1650–6. Moridi K, Moridi K, Moridi K, Moridi K, Hemmaty M, Hemmaty M, et al. Epidemiology of genital infections caused by Mycoplasma hominis, M. genitalium and Ureaplasma urealyticum in Iran; A systematic review and meta-analysis study (2000-2019). BMC Public Health. 2020;20(1):1–13. Silva J, Cerqueira F, Teixeira AL, Bicho MC, Campainha R, Amorim J, et al. Genital mycoplasmas and ureaplasmas in cervicovaginal self-collected samples of reproductive-age women: prevalence and risk factors. Int J STD AIDS. 2018;29(10):999–1006. Waites KB, Katz B, Schelonka RL. Mycoplasmas and ureaplasmas as neonatal pathogens. Clin Microbiol Rev. 2005;18(4):757–89. Mitjà O, Suñer C, Giacani L, Vall-Mayans M, Tiplica GS, Ross JDC, et al. Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis. Lancet Reg Heal - Eur [Internet]. 2023;34:100737. Available from: https://doi.org/10.1016/j.lanepe.2023.100737 Horner P, Donders G, Cusini M, Gomberg M, Jensen JS, Unemo M. Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? – a position statement from the European STI Guidelines Editorial Board. J Eur Acad Dermatology Venereol. 2018;32(11):1845–51. Waites KB, Xiao L, Paralanov V, Viscardi RM, Glass JI. Molecular Methods for the Detection of Mycoplasma and Ureaplasma Infections in Humans. J Mol Diagnostics [Internet]. 2012 Sep;14(5):437–50. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1525157812001432 Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC. Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics. Sex Transm Dis [Internet]. 2009 Oct;36(10):598–606. Available from: https://journals.lww.com/00007435-200910000-00002 Sanders TL, Pareek A, Hewett TE, Levy BA, Dahm DL, Stuart MJ, et al. Long-term rate of graft failure after ACL reconstruction: a geographic population cohort analysis. Knee Surg Sports Traumatol Arthrosc [Internet]. 2017 Jan 13;25(1):222–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27522592 Yu J, Zhou Y, Luo H, Su X, Gan T, Wang J, et al. Mycoplasma genitalium infection in the female reproductive system: Diseases and treatment. Front Microbiol. 2023;14(February):1–12. Bui HTV, Bui HT, Chu S V., Nguyen HT, Nguyen ATV, Truong PT, et al. Simultaneous real-time PCR detection of nine prevalent sexually transmitted infections using a predesigned double-quenched TaqMan probe panel. PLoS One [Internet]. 2023;18(3 March):1–19. Available from: http://dx.doi.org/10.1371/journal.pone.0282439 Ward H, Rönn M. The contribution of STIs to the sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5(4):305–10. Hocking JS, Geisler WM, Kong FYS. Update on the Epidemiology, Screening, and Management of Chlamydia trachomatis Infection. Infect Dis Clin North Am [Internet]. 2023 Jun;37(2):267–88. Available from: https://pubmed.ncbi.nlm.nih.gov/37005162/ Unemo M, Bradshaw CS, Hocking JS, de Vries HJC, Francis SC, Mabey D, et al. Sexually transmitted infections: challenges ahead. Lancet Infect Dis [Internet]. 2017;17(8):e235–79. Available from: http://dx.doi.org/10.1016/S1473-3099(17)30310-9 Zhang D, Li T, Chen L, Zhang X, Zhao G, Liu Z. Epidemiological investigation of the relationship between common lower genital tract infections & high-risk human papillomavirus infections among women in Beijing, China. PLoS One. 2017;12(5):1–11. Magaña-Contreras M, Contreras-Paredes A, Chavez-Blanco A, Lizano M, Cruz-Hernandez YD la, Cruz-Hernandez ED la. Prevalence of sexually transmitted pathogens associated with HPV infection in cervical samples in a Mexican population. J Med Virol [Internet]. 2015 Dec;87(12):2098–105. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jmv.24278 da Silva Barros NK, Costa MC, Alves RRF, Villa LL, Derchain SFM, Zeferino LC, et al. Association of HPV infection and Chlamydia trachomatis seropositivity in cases of cervical neoplasia in Midwest Brazil. J Med Virol [Internet]. 2012 Jul 14;84(7):1143–50. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.23312 Bhatla N, Puri K, Joseph E, Kriplani A, Iyer VK, Sreenivas V. Association of Chlamydia trachomatis infection with human papillomavirus (HPV) & cervical intraepithelial neoplasia - A pilot study. Indian J Med Res. 2013;137(3):533–9. Silva J, Cerqueira F, Medeiros R. Chlamydia trachomatis infection: Implications for HPV status and cervical cancer. Arch Gynecol Obstet. 2014;289(4):715–23. Kim H-S, Kim TJ, Lee I-H, Hong SR. Associations between sexually transmitted infections, high-risk human papillomavirus infection, and abnormal cervical Pap smear results in OB/GYN outpatients. J Gynecol Oncol [Internet]. 2016;27(5):1–11. Available from: https://ejgo.org/DOIx.php?id=10.3802/jgo.2016.27.e49 Jansåker F, Li X, Knudsen JD, Frimodt-Møller N, Borgfeldt C, Sundquist K. The association between common urogenital infections and cervical neoplasia – A nationwide cohort study of over four million women (2002–2018). Lancet Reg Heal - Eur [Internet]. 2022 Jun;17:100378. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2666776222000710 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5930727","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":409550877,"identity":"6b8548e9-7cd8-47f8-a1ed-5451a62a3a6f","order_by":0,"name":"Habtamu Biazin","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Habtamu","middleName":"","lastName":"Biazin","suffix":""},{"id":409550878,"identity":"2e2ac618-a9ea-436e-8dab-a8430837a4e6","order_by":1,"name":"Selamawit Mekuria","email":"","orcid":"","institution":"Skåne University Hospital, Lund University","correspondingAuthor":false,"prefix":"","firstName":"Selamawit","middleName":"","lastName":"Mekuria","suffix":""},{"id":409550879,"identity":"8a709b1d-5fc8-4b45-ada9-20a609435a2c","order_by":2,"name":"Nahom Assegid","email":"","orcid":"","institution":"Armauer Hansen Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Nahom","middleName":"","lastName":"Assegid","suffix":""},{"id":409550880,"identity":"9a996351-2d4c-4efe-ac66-7def2fc5337b","order_by":3,"name":"Ola Forslund","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Ola","middleName":"","lastName":"Forslund","suffix":""},{"id":409550881,"identity":"eaff79c5-d559-4511-b1a3-e9b5f172f514","order_by":4,"name":"Christer Borgfeldt","email":"","orcid":"","institution":"Linköping University","correspondingAuthor":false,"prefix":"","firstName":"Christer","middleName":"","lastName":"Borgfeldt","suffix":""},{"id":409550882,"identity":"2b1ab1c3-a163-42c9-828f-00de74432231","order_by":5,"name":"Mats Jerkeman","email":"","orcid":"","institution":"Skåne University Hospital, Lund University","correspondingAuthor":false,"prefix":"","firstName":"Mats","middleName":"","lastName":"Jerkeman","suffix":""},{"id":409550883,"identity":"90dd1481-189c-40be-8c44-d97788226205","order_by":6,"name":"Adane Mihret","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Adane","middleName":"","lastName":"Mihret","suffix":""},{"id":409550884,"identity":"569364b0-c3b4-410f-91cb-5f303d970ffb","order_by":7,"name":"Tamrat Abebe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYDADAwYeIFkB4UjgU8kDJhNgWs4gtODUhqqFsY0ILfbsp9M+/PzBIG/O3nvw0c15dvIGB5gP3uZhsKnDaQtP7uaZPQkMhjt7ziUb525LNtxwgC3ZmochDY/Dcjcz8CQwMG64kWMmnbuNmXHDAR4zaR6Gw7i18L/dzPgngcF+w/035r9z59TbbzjA/w2o5T9uLRK5m5mBtiRuuMFjxpzbcDgRaAsbUMsB3FpuvN3MLJMmkbyzJy9ZOufY8eSZh9mMLecYJEs24NDC3p+7mfGNjY3tdvazBz/n1FTb9h1vfnjjTYUdPy5boADZFcwgwoCAhlEwCkbBKBgFeAEAglxP373GJmwAAAAASUVORK5CYII=","orcid":"","institution":"Addis Ababa University","correspondingAuthor":true,"prefix":"","firstName":"Tamrat","middleName":"","lastName":"Abebe","suffix":""}],"badges":[],"createdAt":"2025-01-30 13:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5930727/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5930727/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75409166,"identity":"d62f9b43-6dcf-47ab-87d3-83ddb0304856","added_by":"auto","created_at":"2025-02-04 09:02:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":195235,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of seven sexually transmitted microorganisms detected among asymptomatic women in Adama, Ethiopia (n=885)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5930727/v1/98cdf214f874e12bdd3113dc.png"},{"id":75409167,"identity":"5d4d2e44-bfeb-488a-9350-c5e5646693f1","added_by":"auto","created_at":"2025-02-04 09:02:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":241667,"visible":true,"origin":"","legend":"\u003cp\u003eAge specific prevalance of taregetd microorganisms among study population.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5930727/v1/7e0261212e3d4dc3871f301c.png"},{"id":75411509,"identity":"d2bf2a14-dcdc-440e-aa20-2a8b6c2699a2","added_by":"auto","created_at":"2025-02-04 09:10:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":136729,"visible":true,"origin":"","legend":"\u003cp\u003eAge specific prevalence of single and multiple sexually transmitted microorganisms detected(n=568)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5930727/v1/18ab0c2a8b8e80b146103f36.png"},{"id":93325062,"identity":"8d630f12-88e0-4b56-a5cf-8499799c5a25","added_by":"auto","created_at":"2025-10-12 08:31:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2002708,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5930727/v1/e7f4fd0b-9dca-4cf9-86a1-353bcba8eb70.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sexually Transmitted Infections and Association with High-Risk Human Papillomavirus Among Ethiopian Women attending cervical cancer screening","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSexually transmitted infections (STIs) are a global public health issue, with over one million infections acquired daily, the majority without symptoms. It is estimated that 374 million people acquired one of the four treatable STIs (chlamydia, gonorrhea, syphilis, and trichomoniasis) annually, which can lead to complications such as preterm birth, ectopic pregnancy, and infertility (1,2)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMycoplasma genitalium\u003c/em\u003e (MG) is an emerging STI causing nongonococcal urethritis (NGU) in men and cervicitis in women, often occurring alongside other STIs, complicating its role in urogenital diseases. It is linked to preterm delivery, infertility, and pelvic inflammatory disease(PID) (3)(4). Ureaplasma species and \u003cem\u003eMycoplasma hominis\u003c/em\u003e (MH) are prevalent in the genital tracts of sexually active individuals, with varying prevalence based on sexual activity (5\u0026ndash;9). But there is still a lack of study on their clinical relevance (6,9).\u003c/p\u003e\n\u003cp\u003ePCR-based techniques, such as the Allplex\u0026trade; STI Essential Assay, can help define the epidemiology of these infections by detecting multiple microorganisms simultaneously (10). Persistent high-risk HPV (hr-HPV) infection is a known cause of cervical intraepithelial neoplasia (CIN) and cervical cancer (11). Alongside hr-HPV, co-infections with other STIs, such as HIV and genital Chlamydia, have been frequently reported (12\u0026ndash;19).\u003c/p\u003e\n\u003cp\u003eIn Ethiopia, data on STI co-infection with hr-HPV and their role in histological abnormalities is limited. This study aimed to assess the prevalence of specific STIs in asymptomatic, sexually active Ethiopian women and explore correlations with hr-HPV and histopathological findings.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study area and study period\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cohort of reproductive-aged women enrolled in two public prenatal care clinics in Adama, Ethiopia. Adama is one of the cities in the region and has a city administration consisting of 14 urban and four rural kebeles (the smallest unit of administration) with more than 340,000 inhabitants. The city has one referral hospital, three clinics, and more than ten health posts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cohort of 1200 childbearing reproductive women, aged 23-46 years were approached in the cohort. A cohort study was carried out among women participating in community-based cervical cancer screening in Adama, Ethiopia\u003cem\u003e.\u0026nbsp;\u003c/em\u003eA total of 885 women self-collected vaginal swab in the cohort and examined for hr-HPV genotypes and STIs using real-time polymerase chain reaction (RT-PCR) technique. Out of 187 vaginally hrHPV positive women, 116 underwent cervical histopathology testing. The period of sample collection was November 5, 2021, through June 16, 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Sample collection, processing and storage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.1 Sample collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCopan eNat\u0026reg; swab collection and Universal Transport Medium (Copan Italia SpA, Brescia, Italy) was used to collect and transport samples for molecular investigations. The sample was collected November, 2021 to July, 2022. The Copan eNat\u0026reg; medium is a commercially available guanidine thiocyanate-based molecular medium that stabilizes nucleic acids (DNA and RNA) at room temperature for over a month while degrading proteins and inactivating microbial infectivity via cell membrane lysis. The interaction of guanidine thiocyanate with detergents results in inactivation.\u003c/p\u003e\n\u003cp\u003eThe women were supported in collecting the sample by trained data collectors. The training for participants that comprised of a local language-translated presentation of the self-collection apparatus was carried out, and then sample collection took place in a separate room. \u0026nbsp;Every two weeks, a batch of samples was transported from Adama to Addis Ababa University, Department of Microbiology, Immunology, and Parasitology, Molecular Laboratory to be processed and tested.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.2 DNA extraction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDNA was extracted from each cervicovaginal specimen (200 \u0026mu;l) using the StarMag 96 x4 Universal Cartridge Kit (Seegene, Seoul, republic of Korea) by using Seegene MICROLAB Nimbus (Hamilton, Reno, NV, USA) platform, a completely automated liquid handling workstation for nucleic acid extraction and polymerase chain reaction (PCR) setup of up to 72 specimens. DNA was eluted in 100ul elution buffer, according to the manufacturer\u0026rsquo;s instructions and stored at \u0026minus;20 ◦C until further use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.3\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDetection of STIs\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultiplex RT-PCR Allplex\u0026trade; STI Essential Assay (Seegene, Seoul, Korea) was used for testing. The assay can detect seven sexual transmitted microorganisms(STMs) (\u003cem\u003eC. trachomatis, N. gonorrhoeae, T. vaginalis, M. genitalium, M. hominis, U. urealyticum, and U. parvum\u003c/em\u003e) in a single tube using dual priming oligonucleotide (DPO\u0026trade;) and multiple detection temperatures (MuDT\u0026trade;), providing individual Ct values for multiple pathogens in one channel(20). \u0026nbsp;As directed by the manufacturer, Anyplex\u0026trade; STI-EA detection use 5 \u0026mu;l of template DNA and 15 ul of extracted nucleic acid in a total volume of 20 \u0026mu;l. Then, real-time PCR was done by using Allplex\u0026trade; STI essential assay on the CFX96 Bio-Rad real-time thermocycler (Bio-Rad, CA, USA) in associated with the IVD Seegene software. The Real-time PCR was carried out in accordance with the manufacturer\u0026apos;s instructions. The thermal cycle conditions consisted of an initial incubation at 50\u0026nbsp;\u0026nbsp;\u0026nbsp;for 4 min to activate the UDG system and prevent contamination, and pre-denaturation at 95\u0026nbsp;\u0026nbsp;\u0026nbsp;for 15 min, followed by 50 cycles of alternating incubations: 95\u0026nbsp;\u0026nbsp;\u0026nbsp;for 30s, 60\u0026nbsp;\u0026nbsp;\u0026nbsp;for 1 min, and 72\u0026nbsp;\u0026nbsp;\u0026nbsp;for 30s. An internal control (IC, human beta globulin) and positive control were run in each reaction(10). \u003cstrong\u003eHIV status :\u0026nbsp;\u003c/strong\u003eHIV serostatus data was collected from the database of the cohort (21).\u0026nbsp;\u003cstrong\u003eHPV detection and typing\u003c/strong\u003e:\u0026nbsp;HPV detection and typing was performed using a commercial kit, Anyplex II HPV HR (Seegene, Korea), which can detect 14 hr HPV types (i.e., 16, 18, 31, 33, 35, 39, 45, 51,52, 56, 58, 59, 66, and 68) in a single reaction tube by means of real-time PCR assays on the CFX96 real-time PCR instrument (Bio-Rad, Hercules, CA, USA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.4\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eHistological samples:\u0026nbsp;\u003c/strong\u003eHistologic examination was done for 116 hr-HPV positive women. Cervical biopsy samples were collected and placed in screw-capped and labeled bottles containing 10% formol fixative solution before being sent to the pathology laboratory for processing. This cervical biopsy was used for histopathology testing using the standard staining method and evaluated by pathologists. Microscopic examination of the slides revealed the presence of benign alterations, low-grade squamous intraepithelial lesion (CIN1), high-grade squamous intraepithelial lesion (CIN2+), and invasive cervical cancer, as well as normal histology or no dysplasia was found. Finally, the potential relationships between the corresponding histological results and other STIs that are discovered concurrently with cervical HPV infection were determined. A pathologist stained and read the prepared slides, and the Lower Anogenital Squamous Terminology (LAST) report was used to classify them(22). .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were recorded on REDCap and imported to IBM SPSS Statistics, Version 27.0 (Armonk, NY: IBM Corp.) for the statistical analysis. Tables and graphs were used to show the frequency, distribution, and prevalence of the seven sexually transmitted microorganisms. The participants of the study were stratified by age group (\u0026lt;25, 25-29, 30\u0026ndash;34, 35-39, and \u0026ge;40 years) according to WHO health outcome studies (23), and we reported age-specific sexually transmitted microorganisms prevalence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCategorical variables were summarized using absolute frequencies and percentages. Chi-Square or Fisher`s exact test, and logistic regression analyses were conducted to identify factors related to sexually transmitted microorganisms, and association with dysplasia or cervical cancer. In the multivariable analysis, variables with a p-value of less than or equal to 0.2 from the bivariate analysis were taken into account. The association level\u0026nbsp;was determined using an odds ratio with a 95% CI. Variables with p-values less than 5% were considered statistically significant associations between variables and sexually transmitted infections in the multivariable analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Ethical\u003c/strong\u003e \u003cstrong\u003econsideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by ethical review committees at Addis Ababa University, Department of Microbiology, Immunology, and Parasitology (DERC/04/2021), College Ethical Review Board (IRB) (054/21/DMIP), AHRI/ALERT Ethics Review Committee (AAERC) (PO/15/20), and National Ethical Research Review Committee (NERC) (Ref. No. RAS/14.2/8382/21). Before recruitment, each subject provided written informed consent. The STI results were communicated with healthcare providers at Adama Referral Hospital Medical College for further evaluation and treatment. Trial number of the cohort was (https://clinicaltrials.gov/ct2/show/NCT03305991). \u0026nbsp;\u003c/p\u003e\n"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e3.1.\u0026nbsp;Characteristics of the study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study population included 885 women ages ranging from 23 to 46 years, with an average age of 31.82\u0026plusmn;4.32 years. During the data-collecting period, 54 (6.1%) of the study participants reported having experienced signs and symptoms of STIs; of these, 77.8% (n=42) had tested positive for one of the targeted STMs. A correlation was found between the presence of the examined pathogens and the presence of any symptoms (p=0.03). Overall, 11.1%(n=98) of the study participants had a history of sexually transmitted infections (STIs) \u003cstrong\u003e(Table 1)\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1. Characteristics of the study participants and frequency of sexually transmitted microorganisms (N=885)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponses\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTM results\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003ePositive N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eTotal n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026lt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e34(66.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e51(5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e142(66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e216(24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e244(61.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e395(44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e111(64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e172(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026ge;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e37(72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e51(5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e550(64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e860(97.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e*Others\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18(72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e25(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDaily laborer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e79(63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e125 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePermanent job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e137(63.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e216(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHousewife\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e352(65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e544(61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eIlliterate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54(70.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e77(8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026lt;6 grades\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e71(62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e115(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6-12 grades\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e392(64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e608(68.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHigher Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e51(60.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e85(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eHIV status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54(83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e65(7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e514(63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e820(92.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eHistory of STI infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e59(60.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e98(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e505(64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e788(88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eSTI symptoms during the data collection**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e42(78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54(6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e526(63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e831(93.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eLower abdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8(72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e560(63.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e874(98.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eVaginal bleeding\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e566(64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e880(99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eVaginal discharge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e37(84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e44(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e531(63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e841(95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotes: *Others: divorced(n=3)/windowed(n=2)/ single(n=20); ** had more than one STI symptoms; a, Fishers exact test, HIV; human immunodeficiency virus; STM, sexually transmitted microorganisms\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Prevalence pathogens tested among the study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall prevalence of STPs were 64.2% (95% CI:60-67%). The prevalence of NG, CT, and TV were 0.6% (95% CI:0.2- 1.5%,), 1.4% (95% CI:0.7-2.3%), and 2.6% (95% CI:1.6-3.8%), respectively. The magnitude of the NG, CT, and/or TV combined were 4.2% (95% CI:3.0-5.7). The prevalence of MG, MH, UU, and UP were 2.3% (95% CI:0.7-2.3%), 19% (95% CI:16.9-22.2), 23.2(95% CI:20.5-21.1), and 46.6% (95% CI:41-50),\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003erespectively \u003cstrong\u003e(Figure 1)\u003c/strong\u003e.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe rate of mycoplasmas and ureaplasmas species detection was (MG, MH, UU, and UP) 566 (64%, not shown in the figure).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSexually transmitted microorganisms (STMs) prevalence was 83% (54) in women with HIV and 63% (514) in women without HIV (p=0.002). STMs was more frequent among women with HIV than without HIV with odds ratio of 2.7 (95% CI:\u0026nbsp;1.4-5.4, p=0.02). The prevalence of NG, CT, TV and MG among women live with HIV was 3.2, 3.2, 6.5 and 1.6%, respectively. The prevalence of the NG/CT/TV among women living with HIV was 9.1% (6) versus 3.8% (31) among women without HIV. The rate of NG (p=0.046), CT (p=0.23), and TV (p=0.22) was higher among HIV positive women compared to HIV negative women. The odds of getting NG/CT/TV infections in HIV positive women was 2.8 (95% CI:\u0026nbsp;1.5-8.2,\u0026nbsp;p=0.02)\u003cstrong\u003e\u0026nbsp;(Table 2).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2: The prevalence of Sexually transmitted Microorganisms (STMs) among women lives with HIV and without HIV\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTI status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV status n (%) **\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;OR 95% CI\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003ePositive (n=65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eNegative (n=820)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal STMs detected\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e54(83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e514(62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2.7(1.4-5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e3(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e9.1(1.5-55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.046*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e10(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2.7(0.6-12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.23*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e19(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.7(0.1-5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e4(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e19(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2.0(0.6-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.22*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNG/CT/TV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e8(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e47(5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2.8(1.5-8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e23(35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e143(17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2.6(1.5-4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e26(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e180(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2.4(1.4-4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e34(52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e378(46.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1.3(0.8.2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSingle infection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e27(41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e335(40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2.2(1.1-4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultiple infection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e27(41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e179(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e4.2(2-8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Fisher exact test was used, \u003cstrong\u003e**\u003c/strong\u003eproportions calculated in a column, \u003cem\u003eCT: Chlamydia trachomatis; NG: Neisseria gonorrhoeae; TV; Trichomonas vaginalis; MG: Mycoplasma genitalium; MH: Mycoplasma hominis; UU: Ureaplasma urealyticum; UP: Ureaplasma parvum, OR; Odds Ratio, STMs, sexually transmitted microorganisms\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Age specific prevalence of NG, CT, TV, MG, MH, UU, and UP\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe frequency of infection in each age group of women was 67%, 65%, 61%, 64%, \u0026nbsp;and 73%, respectively\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThe age group of \u0026ge; 40 years had the highest detection rate 73%(37/51), followed by the age groups of \u0026lt;25 67%(34/51), and 25-29 66%(142/216). NG, MG, and UU were more prevalent in women aged 25-29, and \u0026lt;25 compared to other age groups. \u0026nbsp;The prevalance of UU decline over the age groups\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ethough the differences were not statistically significant\u003cstrong\u003e(Figure 2)\u003c/strong\u003e. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Co‐infection of rate of detected pathogens\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe frequency of single infections and co-infection among detected microorganisms were 41%(n=362) and 23% (n=206), respectively. The highest frequency of co-infection was reported between MH, and UP, occurred 17.2% (97/568), followed by MH and UU with 15.5% (88/568) for each. NG,\u0026nbsp;CT, MG, and TV had common co-occurrence with UP, MH, UU, and MH, respectively\u0026nbsp;\u003cstrong\u003e(Table 3\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e: The distribution of co-infection among multiple\u0026nbsp;Microorganisms\u0026nbsp;detected\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"641\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMicroorganisms\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCo-infection pathogens n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eNG\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eTV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eMH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eUU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eUP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e7(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6(32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1(6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1(6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e14(30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e7(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e7(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e88(42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e97(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e6(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e5(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e11(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e88(47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e70(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e4(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e4(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e97(52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e70(37.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eCT: Chlamydia trachomatis; NG: Neisseria gonorrhoeae; TV; Trichomonas vaginalis; MG: Mycoplasma genitalium; MH: Mycoplasma hominis; UU: Ureaplasma urealyticum; UP: Ureaplasma parvum; NA= Not applicable\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAge specific incidence of co-infections with two or more sexually transmitted microorganisms was picked age group \u0026lt;25 years, followed by age 30-34 years and declined after wards\u003cstrong\u003e.\u003c/strong\u003e Additionally, the age distribution and co-infection rates varied depending on the pathogen type. Furthermore, the frequencies of co-infection and age distribution varied according to pathogen type. Single infections were more common among women aged 40 or older \u003cstrong\u003e(Figure 3).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Hr-HPV co-infection with other STMs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe co-infection rate of HPV/STMs was 23% (141/614) among hr-HPV and/or STM positive cases. \u003cem\u003eU. parvum\u003c/em\u003e was the most frequently detected pathobiont with 51%, followed by UU in 32%, MH in 31%, TV in 4%, MG in 3.5%, and TV in 2.5% respectively among hr-HPV-positive women. The co-infection rate of HPV/NG was 0.5% (1/191), HPV/CT was 4.2% (8/191), HPV/MG was 3.5% (7/200), HPV/TV was 1.9% (4/206), HPV/MH was 19.7% (58/295), HPV/UU was 18.1% (60/333), and HPV/UP was 16.8% (95/504) (not shown in the table).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe positive rate of high-risk HPV infection was 1.4 times higher in the STMs positive group compared to STMs negative group (AOR=1.4, 95%CI: (0.8-2.7), P=0.26). In the multivariate logistic regression analysis, \u003cem\u003eC. trachomatis\u003c/em\u003e (AOR: 5.4,95% CI: 1.4-21, P=0.014), \u003cem\u003eM. hominis\u0026nbsp;\u003c/em\u003e(AOR:2.0, 95%CI: 1.4-3.0, P=0.001\u003cem\u003e)\u003c/em\u003e, and HIV (AOR:3.6,95% CI: 2.0-6.6, P\u0026lt;0.001) remained the significant associated factors for hrHPV infection \u003cstrong\u003e(Table 4).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4: Association of sexually transmitted microorganisms, and hr-HPV infection with bivariate and multivariate logistic regression\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTI status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHr-HPV status n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR 95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive (N=187)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative (N=698)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal STMs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e141(26.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e427(73.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2(1.3-2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.4(0.8-2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46(15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e271(84.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNG\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.9(0.1-8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.7(0.1-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e186(21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e694(78.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCT\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4(33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.8(2.3-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.4(1.4-21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e179(20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e694(79.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMG\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7(35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13(65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2(.8-5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5(0.5-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e865\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e180(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e685(79.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTV\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4(17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19(82.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.8(.3-2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.6(0.2-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e183(21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e679(78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMH\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58(34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e108(65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.5(1.7-3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.0(1.4-3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e129(17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e590(82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eUU\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60(29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e146(70.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.8(1.3-2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5(0.9-2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e127(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e552(81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eUP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e412\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e95(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e317(76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.2(0.9-1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.2(0.5-2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e92(20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e381(80.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35(53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.6(2.2-6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.2(1.8-5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e157(19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e663(79.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of STMs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e75(20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e287(79.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMultiple\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e66(32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e140(68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.8(1.2-2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.1(0.5-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote:\u0026nbsp;STM, sexually transmitted microorganisms, hr-HPV, high-risk human papillomavirus, CI, confidence interval; COR, crude odds ratio; AOR, adjusted odds ratio;\u003cem\u003e\u0026nbsp;CT: Chlamydia trachomatis; NG: Neisseria gonorrhoeae; TV; Trichomonas vaginalis; MG: Mycoplasma genitalium; MH: Mycoplasma hominis; UU: Ureaplasma urealyticum; UP: Ureaplasma parvum.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.6 Association of STMs, and hrHPV with histological findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 116 histology specimens, 52(45%) was hr-HPV positive, 84(72.4%) were positive for sexually transmitted microorganisms (STMs), 3(2.6%) women were diagnosed with CIN1, 6(5.2%) showed CIN2/3, and 2(1.7%) had invasive cervical cancers. \u0026nbsp;A significant relationship was found between abnormal cervical histology findings and hr-HPV infection (AOR)=22, (95% CI:1.6-308, p=0.02\u003cstrong\u003e).\u0026nbsp;\u003c/strong\u003eA significant association was found between HIV and CIN2+ or cervical cancer (AOR:\u0026nbsp;19, (95%CI :1.8-206, p=0.015)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(\u003cstrong\u003eTable 5).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 5: \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe association between histopathological results with hr-HPV, and detected sexually transmitted microorganisms (n=116) \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfection status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 473px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistological Grades n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eCIN2+*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026le;CIN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eCOR 95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eAOR 95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHr-HPV\u0026sect;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e6(11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e46(84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e7.8(.9-67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e22(1.6-308)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e60(96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5(22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e17(77.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e8.9(1.9-41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e19(1.8-206)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e91(96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall STMs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e6(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e78(92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.2(0.2-6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.2(0.2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e30(93.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e8(7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e107(93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.7(0.4-38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.7(0.03-84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e7(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e104(93.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e8(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e104(92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e3(75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5(0.5-54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.1(0.2-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e7(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e105(93.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5(11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e38(88.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.1(0.7-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.5(0.5-18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e70(96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e33(86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.3(0.3-5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.4(0.3-12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5(6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e73(93.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e55(98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.14(0.16-1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.01(0.2-2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e7(11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e53(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of STMs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eMultiple\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e7(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e37(84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e7.4(0.7-18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e14(0.5-39.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e39(97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoinfection\u003c/strong\u003e\u003cstrong\u003e**\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHPV\u003csup\u003e-\u003c/sup\u003e/STI\u003csup\u003e-\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(6.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e15(93.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHPV only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(6.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e15(93.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.3(0.25-21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSTI only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e46(97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.3(0.25-21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHPV/STI+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e32(86.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e7.2(0.8-64.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: HPV, Human Papillomavirus; CIN, cervical intraepithelial neoplasia; * CIN2+ includes, CIN2,3 and invasive cervical cancers; STMs, sexually transmitted microorganisms; + positive, - negative, \u0026sect; three sample were invalid (1 from CIN2+ and two were from \u0026le;CIN1), **multiple regression adjusted for multicollinearity.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003e4.1. \u0026nbsp;Main conclusions and implications of this study\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall STI prevalence in our study was relatively high (64%). Our finding was higher compared with other studies in Ethiopia which found rates ranging from 14.3-26.6% (24\u0026ndash;26). It was lower than rates found from South Africa (84%) and Ghana (77%) using the same detection methods (27,28). These variations can be explained by differences in study populations, detection techniques, and the number of infectious agents studied. Most other studies focused on pregnant women and sex workers at clinics(29). The high rate of genital infection in our study of asymptomatic women highlights the need for increased awareness among health workers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 NG and CT in this study and others, why they are differed, and implication for treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe infection rate of NG (0.6%), and CT (1.4%) was low in our study. The prevalence of NG in our study was in agreement with the study conducted in Hawassa , Ethiopia (0.7%) by endocervical swabs(30), and Italy (0.4%) by vaginal swab(31). \u0026nbsp;However, lower than the study conducted in Adama, Ethiopia , and \u0026nbsp;in Jimma, Ethiopia \u0026nbsp;with reported value of 3.8% and 9.8% among clinically suspected cases with cervical swabs (32,33), respectively. This variation was attributed to several factors, including differences in study populations, geographical locations, methods of sample collection, and detection methods. For instance, variations in sexual behavior, underlined conditions like HIV, socioeconomic status, and access to healthcare can influence prevalence rates. Additionally, differences in diagnostic techniques and the criteria for selecting study participants may also account for the discrepancies observed. Our findings are similarly consistent with Kenya, where vaginal swab prevalence is reported to be 7.5%(34). Etiological testing that was predicated on STI symptoms and signs or individuals with gynecological complaints may account for these variances. In addition to that the detection methods and the nature of the study group may attribute for these variations. For instance, in our context we included more younger age groups and the HIV prevalence in the town was 2.4% (0.6-6.7%)(35). NG may cause PID in women, epididymitis in men, and neonatal complications why it should be treated even in asymptomatic women. According to current treatment guidelines ceftriaxone is recommended and if CT co-infection doxycycline is used. Patients should be retested three months post-treatment to monitor for reinfection, and sexual partners should also be informed and treated to prevent further transmission. Due to rising antibiotic resistance, healthcare providers must monitor treatment outcomes and report failures to aid in updating treatment protocols(36,37).\u003c/p\u003e\n\u003cp\u003eThe prevalence of CT in our study was in agreement with the study conducted in a cohort of 215 reproductive women in Chad with the same detected method(38). Another report in Italy showed that 4.4% of CT prevalence with the same detection and sampling methods(39). CT may cause serious complications if untreated, including PID, ectopic pregnancy, infertility, epididymitis, reactive arthritis (Reiter\u0026rsquo;s syndrome) or neonatal conjunctivitis or pneumonia, and increased HIV risk. Treatment typically involves doxycycline or, if contraindicated, azithromycin or levofloxacin, with azithromycin preferred during pregnancy. Retesting is recommended three months post-treatment due to high reinfection rates, and partners should be informed and treated to prevent further transmission(37).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 TV in this study and others, why they are differed, and implication for treatment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe infection rate of TV (2.6%) was low in our study. \u0026nbsp;In African populations studies, the estimated prevalence of vaginal TV infection was 11-25% which was significantly higher than in our finding(40). Our prevalence was higher than reports in Italy 1.7% (39) and in Chad 0.4% with the same sampling and detection methods(38). TV causes vaginitis in women, urethritis and prostatitis in men, increased HIV risk, and pregnancy complications such as preterm delivery, low birth weight, and increased risk of neonatal infections. The treatment recommended is metronidazole or tinidazole as first-line with retesting after three months due to high reinfection rates. Sexual partners should be informed, tested, and treated to prevent reinfection, and STI screenings are essential for further prevention(37).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4 MG in this study and others, why they are differed, and implication for treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMycoplasma genitalium\u003c/em\u003e was identified in 2.3% of women in our study. There are significant regional variations in the prevalence of MG infections. Studies from Western Europe, North America, and Australia has estimated that the prevalence of MG varies from 1% to 3.3% in men and from 1% to 6.4% in women(41,42). Our results were consistent with the 2.3% prevalence rates of MG infection reported in an Iranian systematic review and metanalysis (43).However, a study carried out 612 cohort of younger women in Portugal with the same sampling and detection method as ours revealed lower (0.8%) prevalence for MG (44).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.5 MH, UU, and UP in this study and others, and implication for treatment\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of MH (19%), UU (23%), and UP (47%) in the present study. The colonization rates of MH, UU, and UP are significantly higher in the genital tracts of adults, with 30-80% of healthy adult women and 15-30% of healthy adult men harboring Ureaplasma spp. Sexually active adolescents and abused girls are more likely to carry MH and UU/UP than non-sexually active girls(6,7,45). Our findings were in line with the prevalence rates of female genital infections with MH 20%, UU 19%, and UP 45%, according to a systematic review and metanalysis conducted in Iran(43). However, another study carried out 612 cohort of younger women in Portugal with the same sampling and detection method as ours revealed lower prevalence for MH (8.5%), and UP (22.4%), except UU (28.4%) which was comparable with our finding (44).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDiscovering infections caused MG, MH, UU/UP is crucial due to their potential impact on reproductive and sexual health, as well as their role in coinfections. These organisms can cause bacterial vaginosis (BV), pelvic inflammatory disease (PID), urethritis (non-gonococcal and no chlamydial), vaginitis, and adverse pregnancy outcomes like preterm birth and premature membrane rapture(37). Symptomatic infections should be treated to prevent significant discomfort and complications, while treatment for asymptomatic infections is often recommended for pregnant women and high-risk populations. Some infections resolve spontaneously, but monitoring is essential to prevent complications and ensure treatment if symptoms develop(46). Asymptomatic individuals frequently have Mycoplasma and Ureaplasma species detected, indicating colonization rather than active infection(47). Individual risk factors, transmission potential, and the possibility of complications should all be considered when making a treatment decision(48).\u003c/p\u003e\n\u003cp\u003eCo-infections with mycoplasma and other STIs were prevalent in our study. There have been numerous reports of mycoplasma and other STI co-infections(49\u0026ndash;52).\u0026nbsp;In order to select the most effective treatment or treatments and minimize repeat visits, healthcare practitioners should take into account testing women for other genital infections, in addition to CT and NG.\u0026nbsp;It is important to take into account that because of STIs overlapping risk factors and routes of transmission, it is a real possibility co-occurrence of STIs\u0026nbsp;(53). It has been shown in recent research that some STIs might affect how other STI infections develop, either accelerating the course of the illness or changing immune responses(54). There are evidences linking CT and NG coinfection to higher rates of treatment failure and antibiotic resistance(55).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.6 Association between hrHPV and NG, CT, MG, MH, UU, and UP\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eC. trichomatis, M. hominis\u003c/em\u003e, and HIV remained the significant risk factors for hrHPV infection in our study. An epidemiological study in Greece found a link between hr-HPV infection and Ureaplasma species, while studies in China and Mexico found no correlation between hr-HPV and CT, TV, or UU (19,56,57). Studies in Brazil associated \u003cem\u003eC. trachomatis\u003c/em\u003e with high-grade neoplasia in women with HPV; however, an Indian report contradicted this finding about CT(58,59). STIs act as HPV cofactors by causing chronic cervical inflammation and ulceration and by reducing host cell-mediated immunity via their role as HPV cofactors. Infection by high-risk HPV types is crucial to the pathogenesis of invasive cervical cancer (ICC), but other cofactors must be present for the development of malignancy(60). CT biological effect may damage the mucosal barrier, improving HPV infection, or may interfere in immune response and viral clearance supporting the persistence of HPV infection. Moreover, CT-related chronic cervical inflammation, decrease of lower genital tract antigen-presenting cells, inhibition of cell-mediated immunity, and anti-apoptotic capacity may influence the natural history of HPV infection, namely persistence progression or resolution(60).\u003c/p\u003e\n\u003cp\u003eNo correlation was found between abnormal cervical histology and total sexually transmitted microorganisms (STMs) detection in our study. Previous studies supported this finding, showing no correlation between cervical histology and STMs (15,61). However, larger studies have linked common urogenital infections with cervical neoplasia and cervical cancer, emphasizing the importance of STI screening in women with hrHPV (62).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.7 Strengths and limitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study\u0026apos;s main strength is primarily the large patient sample, with 885 patients involved in the research. We conducted the first community-based study of its kind to address pathobionts (UP, UU, and MH) in Ethiopia. Additionally, to minimize variability, molecular assessments (for both HPV and other STMs) have been carried out in a single laboratory affiliated with a university, using cutting-edge molecular assays with robust automated extraction technique.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The main limitation of this, we did not examine the presence of pathogens like herpes simplex virus (HSVs), conditions like bacterial vaginosis or vaginal Candidiasis that may have an additional role either as true pathogens, facilitators, or commensals. Other limitation of the study was, the biopsy results were not guided by colposcopy. \u0026nbsp;\u003c/p\u003e"},{"header":"Summary","content":"\u003cp\u003eOur study revealed a high prevalence of \u003cem\u003eUreaplasma urealyticum,\u003c/em\u003e and \u003cem\u003eMycoplasma hominis\u003c/em\u003e in one out of five and \u003cem\u003eUreaplasma parvum\u003c/em\u003e in almost half of asymptomatic Ethiopian women. In contrast, the prevalence of \u003cem\u003eTrichomonas vaginalis\u003c/em\u003e (3%), \u003cem\u003eMycoplasma genitalium\u003c/em\u003e (2%), \u003cem\u003eChlamydia trachomatis\u003c/em\u003e (1%), and \u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e (less than 1%) was low among asymptomatic Ethiopian women. These findings support the importance of thorough testing with sensitive technologies to avoid unnecessary antibiotic use and guide improvements in Ethiopia\u0026rsquo;s reproductive healthcare system. Larger studies in symptomatic women are recommended.\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eAdjusted odds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eCI\u0026emsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eConfidence interval\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eCIN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eCervical Intraepithelial Neoplasia\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eCIN2+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eCervical Intraepithelial Neoplasia 2 and worse\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eCOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eCrude odds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eChlamydia trachomatis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eHr-HPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eHigh-risk Human Papillomavirus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eMG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eMycoplasma genitalium\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eMH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eMycoplasma hominis\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eNG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eNeisseria gonorrhoeae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eNILM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u0026nbsp;Negative for Intraepithelial Lesion Malignancy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eOdds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003ePID\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003ePelvic inflammatory disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eSTD/Is\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eSexually transmitted diseases/Infections\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eSTPs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eSexually transmitted pathogens\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eSTMs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eSexually transmitted microorganisms\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eTV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eTrichomonas vaginalis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eUP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eUreaplasma parvum\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eUU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eUreaplasma urealyticum\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by ethical review committees at Addis Ababa University, the Department of Microbiology, Immunology, and Parasitology (DERC/04/2021), the College Ethical Review Board (IRB) (054/21/DMIP), the AHRI/ALERT Ethics Review Committee (AAERC) (PO/15/20), and the National Ethical Research Review Committee (NERC) (Ref. No. RAS/14.2/8382/21). Before recruitment, each subject provided written informed consent. The HPV and STI results were communicated with healthcare providers at Adama Referral Hospital Medical College\u0026nbsp;for further evaluation and treatment. ClinicalTrials.gov ID: NCT05125380.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e The data that support the findings of this study are available from the corresponding author upon reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial disclosure:\u003c/strong\u003e All authors declare that they have no competing financial interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e All authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors would like to acknowledge all the collaborators of this work, Lund University, Addis Ababa University, and Armauer Hansen Research Institute and Addis Ababa University Vice President Research for Research and Technology.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHB, and SM research concept and design; HB, NA, and SM \u0026ndash; collection and/or assembly of data; HB-Laboratory work and result interpretation; data analysis and interpretation; drafting and writing the manuscript; OF, CB, TA, AD, and MJ \u0026ndash; critical revision of the manuscript and final approval of article.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Global Health Sector Strategy on Sexually Transmitted Infections 2016\u0026ndash;2021 Implementation Framework for the African Region. WHO Reg Off Africa [Internet]. 2018;1\u0026ndash;30. Available from: https://www.afro.who.int/sites/default/files/2019-03/STI.EN_.pdf\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Who [Internet]. 2021;53(9):1689\u0026ndash;99. Available from: https://www.who.int/publications/i/item/9789240027077\u003c/li\u003e\n\u003cli\u003eMunoz JL, Goje OJ. Mycoplasma genitalium : An Emerging Sexually Transmitted Infection. Scientifica (Cairo) [Internet]. 2016;2016:1\u0026ndash;5. Available from: http://www.hindawi.com/journals/scientifica/2016/7537318/\u003c/li\u003e\n\u003cli\u003eZhang XH, Zhao PZ, Ke WJ, Wang LY, Tso LS, Chen ZY, et al. Prevalence and correlates of Mycoplasma genitalium infection among patients attending a sexually transmitted infection clinic in Guangdong, China: a cross-sectional study. BMC Infect Dis. 2021;21(1):4\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003ePlummer EL, Vodstrcil LA, Bodiyabadu K, Murray GL, Doyle M, Latimer RL, et al. Are Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum Associated with Specific Genital Symptoms and Clinical Signs in Nonpregnant Women? Clin Infect Dis. 2021;73(4):659\u0026ndash;68. \u003c/li\u003e\n\u003cli\u003eParalanov V, Lu J, Duffy LB, Crabb DM, Shrivastava S, Meth\u0026eacute; BA, et al. Comparative genome analysis of 19 Ureaplasma urealyticum and Ureaplasma parvum strains. BMC Microbiol. 2012;12. \u003c/li\u003e\n\u003cli\u003eSong T, Ye A, Xie X, Huang J, Ruan Z, Kong Y, et al. Epidemiological investigation and antimicrobial susceptibility analysis of ureaplasma species and Mycoplasma hominis in outpatients with genital manifestations. J Clin Pathol [Internet]. 2014 Sep;67(9):817\u0026ndash;20. Available from: http://jcp.bmj.com/lookup/doi/10.1136/jclinpath-2014-202248\u003c/li\u003e\n\u003cli\u003eTaylor-Robinson D. Mollicutes in vaginal microbiology: Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum and Mycoplasma genitalium. Res Microbiol [Internet]. 2017;168(9\u0026ndash;10):875\u0026ndash;81. Available from: http://dx.doi.org/10.1016/j.resmic.2017.02.009\u003c/li\u003e\n\u003cli\u003eMcCormack WM, Almeida PC, Bailey PE, Grady EM, Lee YH. Sexual Activity and Vaginal Colonization with Genital Mycoplasmas. JAMA J Am Med Assoc. 1972;221(12):1375\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eChoe HS, Lee DS, Lee SJ, Hong SH, Park DC, Lee MK, et al. Performance of Anyplex\u003csup\u003eTM\u003c/sup\u003e II multiplex real-time PCR for the diagnosis of seven sexually transmitted infections: Comparison with currently available methods. Int J Infect Dis. 2013;17(12):1134\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eZur Hausen H. Papillomaviruses in human cancers. Proc Assoc Am Physicians. 1999;111(6):581\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eParthenis C, Panagopoulos P, Margari N, Kottaridi C, Spathis A, Pouliakis A, et al. The association between sexually transmitted infections, human papillomavirus, and cervical cytology abnormalities among women in Greece. Int J Infect Dis [Internet]. 2018;73:72\u0026ndash;7. Available from: https://doi.org/10.1016/j.ijid.2018.06.001\u003c/li\u003e\n\u003cli\u003ePouryasin M, Mousavi AS, Pakravesh J, Kamel DZ, Nooriardabili S, Khodadad S, et al. The Prevalence of HPV and non-HPV STIs Among Iranian Women and Assessment of the HPV/non-HPV STIs Co-infection on Cervical Cell Changes. J Obstet Gynecol Cancer Res. 2022;7(5):405\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eMartinelli M, Musumeci R, Sechi I, Sotgiu G, Piana A, Perdoni F, et al. Prevalence of human papillomavirus (HPV) and other sexually transmitted infections (STIS) among italian women referred for a colposcopy. Int J Environ Res Public Health. 2019;16(24). \u003c/li\u003e\n\u003cli\u003eAlotaibi HJ, Almajhdi FN, Alsaleh AN, Obeid DA, Khayat HH, Al-Muammer TA, et al. Association of sexually transmitted infections and human papillomavirus co-infection with abnormal cervical cytology among women in Saudi Arabia. Saudi J Biol Sci [Internet]. 2020;27(6):1587\u0026ndash;95. Available from: https://doi.org/10.1016/j.sjbs.2020.03.021\u003c/li\u003e\n\u003cli\u003eValasoulis G, Pouliakis A, Michail G, Magaliou I, Parthenis C, Margari N, et al. Cervical HPV Infections, Sexually Transmitted Bacterial Pathogens and Cytology Findings\u0026amp;amp;#x2014;A Molecular Epidemiology Study. Pathogens. 2023;12(11). \u003c/li\u003e\n\u003cli\u003eHong SR, Kim TJ, Lee IH, Kim HS. Relationships of Sexually Transmitted Infections, Bacterial (STI) with High-Risk Human Papillomavirus (HR-HPV) and Abnormal Cervical Cytology in Gynecological Outpatients. J Am Soc Cytopathol [Internet]. 2015;4(6):S34. Available from: http://dx.doi.org/10.1016/j.jasc.2015.09.080\u003c/li\u003e\n\u003cli\u003eLi W, Liu LL, Luo ZZ, Han CY, Wu QH, Zhang L, et al. Associations of sexually transmitted infections and bacterial vaginosis with abnormal cervical cytology: A cross-sectional survey with 9090 community women in China. PLoS One [Internet]. 2020;15(3):1\u0026ndash;12. Available from: http://dx.doi.org/10.1371/journal.pone.0230712\u003c/li\u003e\n\u003cli\u003eChoi SH, Jin H, Lee KE. Prevalence of Sexually Transmitted Pathogen Coinfections in High Risk-Human Papillomaviruses Infected Women in Busan. Biomed Sci Lett. 2019;25(4):390\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eChun JY, Kim KJ, Hwang IT, Kim YJ, Lee DH, Lee IK, et al. Dual priming oligonucleotide system for the multiplex detection of respiratory viruses and SNP genotyping of CYP2C19 gene. Nucleic Acids Res. 2007;35(6):6\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eWalles JK, Tesfaye F, Jansson M, Balcha TT, Winqvist N, Kefeni M, et al. Performance of QuantiFERON-TB gold plus for detection of latent tuberculosis infection in pregnant women living in a tuberculosis- and HIV-endemic setting. PLoS One. 2018;13(4):1\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eDarragh TM, Colgan TJ, Thomas Cox J, Heller DS, Henry MR, Luff RD, et al. The Lower Anogenital Squamous Terminology Standardization Project for HPV-associated Lesions. Int J Gynecol Pathol [Internet]. 2013 Jan;32(1):76\u0026ndash;115. Available from: http://journals.lww.com/00004347-201301000-00012\u003c/li\u003e\n\u003cli\u003eBray F, Ferlay J. Chapter 7 : Age standardization. 1954;0\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eKassie BA, Yenus H, Berhe R, Kassahun EA. Prevalence of sexually transmitted infections and associated factors among the University of Gondar students, Northwest Ethiopia: A cross-sectional study. Reprod Health. 2019;16(1):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eTamrat R, Kasa T, Sahilemariam Z, Gashaw M. Prevalence and Factors Associated with Sexually Transmitted Infections among Jimma University Students, Southwest Ethiopia. Int J Microbiol. 2020;2020. \u003c/li\u003e\n\u003cli\u003eSch\u0026ouml;nfeld A, Feldt T, Tufa TB, Orth HM, Fuchs A, Mesfun MG, et al. Prevalence and impact of sexually transmitted infections in pregnant women in central Ethiopia. Int J STD AIDS. 2018;29(3):251\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eMoodley C, Tootla H, Amien I, Engel ME. Evaluating the utility of the Allplex STI Essential Assay to determine the occurrence of urogenital sexually transmitted infections among symptomatic and asymptomatic patients in Cape Town, South Africa. Bruisten SM, editor. PLoS One [Internet]. 2023 Nov 29;18(11):e0292534. Available from: https://dx.plos.org/10.1371/journal.pone.0292534\u003c/li\u003e\n\u003cli\u003eSylverken AA, Owusu-Dabo E, Yar DD, Salifu SP, Awua-Boateng NY, Amuasi JH, et al. Bacterial etiology of sexually transmitted infections at a STI clinic in Ghana; use of multiplex real time PCR. Ghana Med J. 2016;50(3):142\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAnbesu EW, Aychiluhm SB, Alemayehu M, Asgedom DK, Kifle ME. A systematic review and meta-analysis of sexually transmitted infection prevention practices among Ethiopian young people. SAGE Open Med. 2023;11. \u003c/li\u003e\n\u003cli\u003eTadesse E, Teshome M, Amsalu A, Shimelis T. Genital Chlamydia trachomatis Infection among Women of Reproductive Age Attending the Gynecology Clinic of Hawassa University Referral Hospital , Southern. 2016;1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eLeli C, Mencacci A, Agnese M, Clerici P, Rassu M, Perito S, et al. Prevalence of cervical colonization by Ureaplasma parvum , Ureaplasma urealyticum , Mycoplasma hominis and Mycoplasma genitalium in childbearing age women by a commercially available multiplex real-time PCR : An Italian observational multicentre study. J Microbiol Immunol Infect. 2018;51(2):220\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eTadse Grenfes and DG. Neisseria gonorrhoeae and their Antimicrobial Susceptibility Patterns among Patients from Adama Town, Ethiopia. :1\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eSahile A, Teshager L, Fekadie M, Gashaw M. Prevalence and Antimicrobial Susceptibility Patterns of Neisseria gonorrhoeae among Suspected Patients Attending Private Clinics in Jimma , Ethiopia. 2020;2020. \u003c/li\u003e\n\u003cli\u003eOladokun A. Prevalence of genital Chlamydia trachomatis among women of reproductive age attending outpatient clinic at Kisumu County Referral Hospital, Kenya, 2021. 2022;13(3):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eEthiopian Public Health Institute. HIV Related Estimates and Projections in Ethiopia for the Year 2021-2022 August 2022 Addis Ababa. Gmf [Internet]. 2023;(May):1\u0026ndash;32. Available from: https://ephi.gov.et/wp-content/uploads/2021/02/HIV-Estimates-and-projection-for-the-year-2022-and-2023.pdf\u003c/li\u003e\n\u003cli\u003eNguyen PTT, Pham HV, Van DH, Pham L Van, Nguyen HT, Nguyen H Van. Randomized controlled trial of the relative efficacy of high-dose intravenous ceftriaxone and oral cefixime combined with doxycycline for the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae co-infection. BMC Infect Dis [Internet]. 2022;22(1):1\u0026ndash;9. Available from: https://doi.org/10.1186/s12879-022-07595-w\u003c/li\u003e\n\u003cli\u003eHazra A, Collison MW, Davis AM. CDC Sexually Transmitted Infections Treatment Guidelines, 2021. JAMA [Internet]. 2022 Mar 1;327(9):870. Available from: https://jamanetwork.com/journals/jama/fullarticle/2789560\u003c/li\u003e\n\u003cli\u003eCompain F, Nodjikouambaye ZA, Sadjoli D, Moussa AM, Adawaye C, Bouassa R-SM, et al. Low Prevalence of Common Sexually Transmitted Infections Contrasting with High Prevalence of Mycoplasma Asymptomatic Genital Carriage: A Community-Based Cross-Sectional Survey in Adult Women Living in N\u0026rsquo;Djamena, Chad. Open Microbiol J. 2019;13(1):222\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eBianchi S, Frati ER, Canuti M, Colzani D, Fasoli E, Amendola A, et al. Molecular epidemiology and genotyping of Chlamydia trachomatis infection in a cohort of young asymptomatic sexually active women (18-25 years) in Milan, Italy. J Prev Med Hyg. 2016;57(3):E128\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eMabaso N, Abbai NS. A review on Trichomonas vaginalis infections in women from Africa. South African J Infect Dis. 2021;36(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eSalado-Rasmussen K, Jensen JS. Mycoplasma genitalium testing pattern and macrolide resistance: A Danish nationwide retrospective survey. Clin Infect Dis. 2014;59(1):24\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eJensen JS, Cusini M, Gomberg M, Moi H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatology Venereol. 2016;30(10):1650\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eMoridi K, Moridi K, Moridi K, Moridi K, Hemmaty M, Hemmaty M, et al. Epidemiology of genital infections caused by Mycoplasma hominis, M. genitalium and Ureaplasma urealyticum in Iran; A systematic review and meta-analysis study (2000-2019). BMC Public Health. 2020;20(1):1\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eSilva J, Cerqueira F, Teixeira AL, Bicho MC, Campainha R, Amorim J, et al. Genital mycoplasmas and ureaplasmas in cervicovaginal self-collected samples of reproductive-age women: prevalence and risk factors. Int J STD AIDS. 2018;29(10):999\u0026ndash;1006. \u003c/li\u003e\n\u003cli\u003eWaites KB, Katz B, Schelonka RL. Mycoplasmas and ureaplasmas as neonatal pathogens. Clin Microbiol Rev. 2005;18(4):757\u0026ndash;89. \u003c/li\u003e\n\u003cli\u003eMitj\u0026agrave; O, Su\u0026ntilde;er C, Giacani L, Vall-Mayans M, Tiplica GS, Ross JDC, et al. Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis. Lancet Reg Heal - Eur [Internet]. 2023;34:100737. Available from: https://doi.org/10.1016/j.lanepe.2023.100737\u003c/li\u003e\n\u003cli\u003eHorner P, Donders G, Cusini M, Gomberg M, Jensen JS, Unemo M. Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? \u0026ndash; a position statement from the European STI Guidelines Editorial Board. J Eur Acad Dermatology Venereol. 2018;32(11):1845\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eWaites KB, Xiao L, Paralanov V, Viscardi RM, Glass JI. Molecular Methods for the Detection of Mycoplasma and Ureaplasma Infections in Humans. J Mol Diagnostics [Internet]. 2012 Sep;14(5):437\u0026ndash;50. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1525157812001432\u003c/li\u003e\n\u003cli\u003eGaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC. Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics. Sex Transm Dis [Internet]. 2009 Oct;36(10):598\u0026ndash;606. Available from: https://journals.lww.com/00007435-200910000-00002\u003c/li\u003e\n\u003cli\u003eSanders TL, Pareek A, Hewett TE, Levy BA, Dahm DL, Stuart MJ, et al. Long-term rate of graft failure after ACL reconstruction: a geographic population cohort analysis. Knee Surg Sports Traumatol Arthrosc [Internet]. 2017 Jan 13;25(1):222\u0026ndash;8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27522592\u003c/li\u003e\n\u003cli\u003eYu J, Zhou Y, Luo H, Su X, Gan T, Wang J, et al. Mycoplasma genitalium infection in the female reproductive system: Diseases and treatment. Front Microbiol. 2023;14(February):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eBui HTV, Bui HT, Chu S V., Nguyen HT, Nguyen ATV, Truong PT, et al. Simultaneous real-time PCR detection of nine prevalent sexually transmitted infections using a predesigned double-quenched TaqMan probe panel. PLoS One [Internet]. 2023;18(3 March):1\u0026ndash;19. Available from: http://dx.doi.org/10.1371/journal.pone.0282439\u003c/li\u003e\n\u003cli\u003eWard H, R\u0026ouml;nn M. The contribution of STIs to the sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5(4):305\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eHocking JS, Geisler WM, Kong FYS. Update on the Epidemiology, Screening, and Management of Chlamydia trachomatis Infection. Infect Dis Clin North Am [Internet]. 2023 Jun;37(2):267\u0026ndash;88. Available from: https://pubmed.ncbi.nlm.nih.gov/37005162/\u003c/li\u003e\n\u003cli\u003eUnemo M, Bradshaw CS, Hocking JS, de Vries HJC, Francis SC, Mabey D, et al. Sexually transmitted infections: challenges ahead. Lancet Infect Dis [Internet]. 2017;17(8):e235\u0026ndash;79. Available from: http://dx.doi.org/10.1016/S1473-3099(17)30310-9\u003c/li\u003e\n\u003cli\u003eZhang D, Li T, Chen L, Zhang X, Zhao G, Liu Z. Epidemiological investigation of the relationship between common lower genital tract infections \u0026amp; high-risk human papillomavirus infections among women in Beijing, China. PLoS One. 2017;12(5):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eMaga\u0026ntilde;a-Contreras M, Contreras-Paredes A, Chavez-Blanco A, Lizano M, Cruz-Hernandez YD la, Cruz-Hernandez ED la. Prevalence of sexually transmitted pathogens associated with HPV infection in cervical samples in a Mexican population. J Med Virol [Internet]. 2015 Dec;87(12):2098\u0026ndash;105. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jmv.24278\u003c/li\u003e\n\u003cli\u003eda Silva Barros NK, Costa MC, Alves RRF, Villa LL, Derchain SFM, Zeferino LC, et al. Association of HPV infection and Chlamydia trachomatis seropositivity in cases of cervical neoplasia in Midwest Brazil. J Med Virol [Internet]. 2012 Jul 14;84(7):1143\u0026ndash;50. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.23312\u003c/li\u003e\n\u003cli\u003eBhatla N, Puri K, Joseph E, Kriplani A, Iyer VK, Sreenivas V. Association of Chlamydia trachomatis infection with human papillomavirus (HPV) \u0026amp; cervical intraepithelial neoplasia - A pilot study. Indian J Med Res. 2013;137(3):533\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eSilva J, Cerqueira F, Medeiros R. Chlamydia trachomatis infection: Implications for HPV status and cervical cancer. Arch Gynecol Obstet. 2014;289(4):715\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eKim H-S, Kim TJ, Lee I-H, Hong SR. Associations between sexually transmitted infections, high-risk human papillomavirus infection, and abnormal cervical Pap smear results in OB/GYN outpatients. J Gynecol Oncol [Internet]. 2016;27(5):1\u0026ndash;11. Available from: https://ejgo.org/DOIx.php?id=10.3802/jgo.2016.27.e49\u003c/li\u003e\n\u003cli\u003eJans\u0026aring;ker F, Li X, Knudsen JD, Frimodt-M\u0026oslash;ller N, Borgfeldt C, Sundquist K. The association between common urogenital infections and cervical neoplasia \u0026ndash; A nationwide cohort study of over four million women (2002\u0026ndash;2018). Lancet Reg Heal - Eur [Internet]. 2022 Jun;17:100378. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2666776222000710\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ethiopia, Human papillomavirus, Multiplex RT-PCR, Self-sampling, sexually transmitted pathogens","lastPublishedDoi":"10.21203/rs.3.rs-5930727/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5930727/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eSexually transmitted infections (STIs) continue to be a major public health concern and threat on a global scale. This study aimed to determine the prevalence and association of STIs coinfection with hrHPV and histological findings in a cohort of women attending cervical cancer screening with self-sampling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e This study was based on a cohort of 885 reproductive-aged women was attending cervical cancer screening at public prenatal care clinics in Adama, Ethiopia. The detection was performed by using the Allplex™ STI-EA real-time multiplex kit with the CFX96™ thermal cycler (Bio-Rad, CA, USA). The Seegene Anyplex II HPV HR test kit was used for the simultaneously detection of 14 hrHPV genotypes. Multivariable logistic regression analyses were made to test the association between the variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eOf all the study participants, 568 (64.2%) had at least one sexually transmitted microorganism (95% CI: 61-67). The overall prevalence of: \u003cem\u003eNeisseria gonorrhea\u003c/em\u003e (NG) was 0.6% (95% CI: 0.2-1.5), \u003cem\u003eChlamydia trachomatis\u003c/em\u003e (CT) 1.4% (95% CI: 0.7-2.3), \u003cem\u003eTrichomonas vaginalis\u003c/em\u003e (TV) 2.6% (95% CI: 1.6-3.8), \u003cem\u003eMycoplasma genitalium\u003c/em\u003e (MG) 2.3% (95% CI: 1.4-3.5), \u003cem\u003eMycoplasma\u003c/em\u003e \u003cem\u003ehominis\u003c/em\u003e (MH) 19% (95% CI: 16-22), \u003cem\u003eUreaplasma urealyticum\u003c/em\u003e (UU) 23.2% (95% CI: 20.5-26.1), and \u003cem\u003eUreaplasma parvum\u003c/em\u003e (UP) 46.6% (95% CI: 43-50). The prevalence of NG, CT, and TV infection was 4.2% (37). There was correlation between CT (adjusted odds ratio (AOR)=5.4, 95% CI=1.4-21, p=0.014), MH (AOR=2.0, 95% CI= 1.4-3.0, p=0.001), HIV status (AOR=3.6, 95% CI= 2.0-6.6, P\u0026lt;0.001) with high-risk HPV infection. Hr-HPV infection was independently associated with histological abnormalities (AOR=14.8, 95% CI:1.1-19.9, p=0.043).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study revealed a high prevalence of UU and MH in one out of five and UP in almost half of asymptomatic Ethiopian women. The prevalence of TV, MG, CT, and NG was low. There was a link between CT, MH, and HIV status and high-risk HPV infection. A high-risk-human papillomavirus and HIV infection was independently linked with histological abnormalities.\u003c/p\u003e","manuscriptTitle":"Sexually Transmitted Infections and Association with High-Risk Human Papillomavirus Among Ethiopian Women attending cervical cancer screening","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-04 09:02:38","doi":"10.21203/rs.3.rs-5930727/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b251c8c2-9148-49e8-b4c5-82c00eac5522","owner":[],"postedDate":"February 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-12T08:23:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-04 09:02:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5930727","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5930727","identity":"rs-5930727","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}