Prevalence of herpes simplex type 2 and syphilis serology among young adults in a rural Gambian community

Objectives: To estimate prevalence and risk factors for herpes simplex 2 (H SV2) positivity, syphilis and Chlamydia trachomatis infection among rural p eople aged 15-34 in the Gambia. Methods: Questionnaires and serum samples were collected from 1076 men and women aged 15-34 during a cross sectional prevalence survey in a rural area of the Gambia. Sera were screened for antibodies to herpes simplex virus t ype 2 (HSV2), and for syphilis using Treponema pallidum haemagglutination a ssay (TPHA) and rapid plasma reagin (RPR) tests. Urine was tested by polyme rase chain reaction (PCR) for C trachomatis infection. Results: 28% of women and 5% of men were HSV2 ELISA positive; 10% of women and 2% of men were TPHA positive; and 7% of women and 1% of men were both R PR and TPHA positive. Out of 1030 urine sample tested only six were positiv e for C trachomatis. 7% of those who reported never having sex were positiv e for one or other of these tests. Prevalences of all STIs increased with a ge and were higher in women than men. Women were much less likely than men to seek treatment for STI symptoms at a health centre. Married people were at increased risk of an STI compared with single people. Jola and Fula wome n had a higher prevalence of HSV2 than women from other ethnic groups, and Fulas also had a higher prevalence of RPR/TPHA positivity. The limited numb er of sexual behaviour questions were not significantly associated with STI s after adjustment for age, marital status, and ethnic group. Conclusions: The prevalences of the ulcerative infections HSV2 and syphilis in this population are a cause for concern. In a setting where HIV I preva lence remains low this indicates an urgent need for STI control and behavio ur change programmes to prevent an HIV epidemic. Concerns about the validit y of reported sexual behaviour data high light the necessity of biological markers in the evaluation of behaviour change programmes.