Kemri report reveals high STI prevalence among adolescents
STI symptoms were defined based on self-reports of abnormal/foul-smelling discharge, lower abdominal pain, pain or burning with urination, and genital sore or ulcer.
What you need to know:
- The researchers tested urine specimens of 1, 167 adolescents.
- Those surveyed were questioned about their sexual history, STI risk perceptions and STI symptoms, diagnosis and treatment history.
Adolescents who live in Kisumu’s informal settlements and are sexually active are likely to have chlamydia or gonorrhea, or both, according to a new report by the Kenya Medical Research Institute. (Kemri)
The study titled “Prevalence of chlamydia and gonorrhea among Kenyan adolescents” was conducted in collaboration with the University of California San Francisco between February 2020 and May 2021.
The researchers tested urine specimens of 1, 167 adolescents. Those surveyed were questioned about their sexual history, STI (sexually transmitted infections risk perceptions and STI symptoms, diagnosis and treatment history.
Also read: Men, genital warts, and HPV
STI symptoms were defined based on self-reports of abnormal/foul-smelling discharge, lower abdominal pain, pain or burning with urination, and genital sore or ulcer.
Participants who reported having engaged in sex during the survey or during their HIV/STI pre-test counselling session were eligible for urine testing for the sexually transmitted infections.
One in 100 sexually active adolescents tested positive for chlamydia or gonorrhea, with a large proportion being girls. Some 617 girls (18–19 years) were surveyed, mostly students or secondary school graduates.
Some 423 participants reported recent sexual activity within the past month.
Seven hundred and fifteen reported using condoms during the last sex. At least 55 had a prior STI diagnosis, while 635 expressed worry about contracting an STI.
“At least 111 adolescents had a positive STI test result - 102 tested positive for chlamydia (69 girls, 33 boys) and 15 were positive for gonorrhoea (13 girls, 2 boys). Six were positive for both chlamydia and gonorrhoea (five girls, one boy),” notes the study, which was published in the National Library of Medicine
Among the 86 adolescents who did not report engaging in sexual activity in the survey, five had a positive STI test result. Ninety-two were linked to care and received treatment (64 girls, 28 boys), 12 (nine girls, three boys) declined to be linked to care and seven (five girls, two boys) could not be reached after multiple attempts by the study team.
Visible symptoms
Currently, Kenya primarily relies on syndromic management for STI diagnosis, where treatment is based on identification of visible symptoms, without laboratory testing. However, the researchers point out that many STIs are asymptomatic; therefore, relying on syndromic management may underestimate prevalence.
“Kenya uses syndromic management to diagnose STIs, thus the prevalence of chlamydia and gonorrhoea among adolescents is likely underestimated due to undiagnosed asymptomatic infections. Undiagnosed and untreated STIs can cause resultant significant complications, including pelvic inflammatory disease, infertility and chronic pelvic pain, and can be transmitted to sexual partners and during pregnancy and delivery. In addition, STIs increase the risk of HIV acquisition and transmission,” said the researchers.
They explained that some adolescents did not report being sexually active during the survey but later acknowledged their risk during the HIV pre-test counselling, pointing to social stigma regarding adolescent sexuality.
“Fear of sexuality stigma often inhibits adolescents from disclosing to providers that they engage in sexual activities, placing them at risk for STI acquisition, which may result in undiagnosed cases. Nearly 95 per cent of adolescents who were offered STI testing accepted. The high rate of uptake suggests that self-collection of urine is a feasible option for testing in settings outside of health facilities. Ease of collection and high diagnostic accuracy using urine specimens make this approach a good STI testing method for adolescents and other age groups,” the researchers noted.
STIs are a major public health concern globally. The World Health Organization estimates that in 2020, there were 129 million new chlamydia infections and 82million new gonorrhea infections in adults aged 15–49 years
Countries in sub-Saharan Africa comprise 40 per cent of the global STI burden. The WHO African region had the highest chlamydia prevalence among men and gonorrhoea prevalence among women and men. Besides, the prevalence of chlamydia and gonorrhea among youth in sub-Saharan Africa range from seven per cent to 17 per cent.
Meanwhile, the United Kingdom is pioneering a vaccine for gonnorhoea using an existing jab known as 4CMenB that is used to treat meningococcal B disease, which can cause meningitis and sepsis. It is used in the routine childhood programme and given to babies at eight weeks, 16 weeks and one year.
The jab contains proteins from neisseria meningitidis – the bacteria that causes meningococcal disease – which is closely genetically related with neisseria gonorrhoeae, the bacteria that causes gonorrhoea.
Studies by the Joint Committee on Vaccination and Immunisation suggest the 4CMenB vaccine has between 32.7 per cent to 42 per cent effectiveness against gonorrhoea, and while vaccination would slash the risk of becoming infected, it would not eliminate it completely.
