PONE-D-24-03237Estimates of the incidence, prevalence, and factors associated with common sexually transmitted infections among Lebanese womenPLOS ONE

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Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Congratulations to the authors for their insightful exploration of a critical yet underexplored subject – the prevalence of STIs among Lebanese women. This research brings much-needed attention to a crucial public health issue in a region where such studies are limited, providing valuable insights that can inform targeted interventions and policies.

When it comes to specific suggestions for improvement, in the introduction, mentioning the specific situation in Lebanon would be highly relevant, as the article focuses on STI prevalence among Lebanese women. The author could address the socio-cultural factors, healthcare infrastructure, and challenges in Lebanon that contribute to the observed STI prevalence. This would provide a more comprehensive and localized perspective on the issue.

Moving to the "Subject and Methods" section, consider dividing "Study Subjects" into two distinct subtopics: "Study Participants" and "Data Collection." This structural adjustment will enhance the organization of information, providing readers with a clearer delineation of the study's participant details and the data collection methodology.

To enhance the Results section, begin with a brief summary outlining the key findings, highlighting the overall prevalence of STIs and any noteworthy trends. Additionally, organize the presentation of prevalence rates in a clearer structure by grouping related rates together, possibly using subsections or a table. This adjustment will improve readability and the logical flow of information for the reader.

In the Discussion section, deepen the interpretation of prevalence rates by exploring cultural, economic, and healthcare access factors specific to Lebanon. While the brief mention of higher-than-expected prevalence rates is noted, a more detailed comparative analysis with global estimates and other regions would be interesting. Provide a more detailed comparison of your findings with other relevant studies, especially those conducted in the Middle East and North Africa region. Strengthen this section by emphasizing specific interventions and strategies for improvement. Regarding geographical patterns, although mentioned, further exploration of their implications and recommendations for addressing healthcare disparities would enhance this section.

On page 8, when mentioning "HR and LR HPV," ensure that abbreviations and acronyms are defined upon first use for clarity.

Your study holds significant promise, and these suggested improvements only aim to enhance its impact. Your efforts in addressing these aspects will undoubtedly contribute to the advancement of knowledge in this important field. Keep up the great work!

Reviewer #2: I consider the paper relevant but need some explanation about the topics below.

The article does not clarify whether the tested women attended the gynecology outpatient clinic with complaints (symptoms or clinical signs) or just for routine gynecological check-ups (preventive). There is also no confirmation whether among the examined women there pregnant women and any reference to the gestational period of these ones were. This fact could impact the discovery of STIs by the research.

I suggest to the authors that they separate the group of women without sexual partners from those with one partner and those with two or more sexual partners. Otherwise, it is necessary to detail in the materials and methods because the separation was not made. I also understand it is necessary to establish unequivocally the period reflected by the number of sexual partners, as only using the expression " lifetime sexual partners " in the discussion is not sufficient.

I am curious about the information regarding whether there is a statistically significant difference between the median age of the participants and a positive result for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and Treponema pallidum.

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Reviewer #1: No

Reviewer #2: Yes: Edilbert Pellegrini Nahn Junior

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Submitted filename: Reviewer Comments.pdf

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Submitted filename: Review.pdf

Estimates of the incidence, prevalence, and factors associated with common sexually transmitted infections among Lebanese women

PONE-D-24-03237R1

Dear Dr. Almawi,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Angelica Espinosa Miranda, M.D., Ph.D.

Academic Editor

PLOS ONE