Association of Cervical Ectopy with Heterosexual Transmission of Human Immunodeficiency Virus: Results of a Study of Couples in Nairobi, Kenya

Between June 1988-February 1989 physicians enrolled 70 couples attending the Nairobi City Commission Special Treatment Clinic for STDs (Sexually Transmitted) Diseases) to determine the incidence of and risk factors for heterosexual transmission of HIV in couples of stable sexual relationships. All the men were HIV seropositive. 57% of the women also tested positive for HIV. Only 6 couples had used condoms within the last 3 months after earlier receiving STD counseling at the clinic and the 6 women were HIV seronegative. Even though there was a correlation between HIV infection and the following factors the correlation was not significant: sex during menses oral contraceptive (OC) use since 1980 blood transfusion since 1980 Trachoma vaginalis and Neisseria gonorrhoea. The study supported earlier research that found an association between cervical ectopy and OC use and between cervical ectopy and pregnancy. More importantly the univariate analysis showed that 71% of HIV positive women exhibited cervical ectopy whereas only 10% of HIV negative women did (odds ratio [OR] 4.7; p=006). Further this association remained significant even after controlling for confounding variables (OR 5; p=.007). No other statistically significant predictor of HIV seropositivity emerged during the analysis. Researchers need to conduct prospective studies to examine this association. If these studies support the results of this study this finding could have significant public health ramifications. Nevertheless the researchers suggested that since more vessels are present in the columnar epithelium which make up a cervical ectopy and hemorrhages more easily with trauma than squamous epithelium cervical ectopy may indeed promote HIV entry.