Prevalence & Risk Factors of Three Curable Sexually Transmitted Infections among Women in Nairobi, Kenya

BACKGROUND:

Sexually transmitted infections (STIs) are a major public health problem, especially in developing countries. The complications of untreated STIs in the female genital tract and their role in adverse pregnancy and perinatal outcomes have been well documented. The prevalence of STIs in Kenya among women in the general population has not been extensively studied and there is a lack of guidelines for screening of non-pregnant women. Knowledge of the prevalence of curable STIs among this population can provide a basis for integrating STI screening in family planning clinics.

METHODS:

A cross-sectional study was conducted between May and September 2013 at the family planning (FP) clinic at Kenyatta National Hospital (KNH) in Nairobi, Kenya. A total of 261 participants aged 18-49 years were enrolled; with data from 249 participants being analysed. An interviewer-administered questionnaire was used to gather socio-demographic data and assess for risk factors. Each participant was screened for Trichomonas vaginalis (TV) by wet mount microscopy; Neisseria gonorrhoeae (GC) by culture and Chlamydia trachomatis (CT) by PCR.

RESULTS:

The prevalence of CT was 13 % (33/249), TV 0.4 % (1/249) and GC 0 % (0/249). All the infected women reported having had only one sexual partner in the previous 1 year. The age group prevalence for CT was highest in the 25-29 years age group (21 %). The syndromic approach to the management of STIs showed a low specificity (vaginal discharge, 65.7 %; lower abdominal pain, 60.6 %) and positive predictive value (vaginal discharge, 14 %; lower abdominal pain, 11.5 %) for the two commonly used symptoms when compared to the gold standard of CT PCR.

CONCLUSION:

A high prevalence of CT was identified among women attending the FP Clinic at KNH. The study reinforces the need to implement regular screening for STIs among FP clinic attendants. It also reveals the need to review the usage of the syndromic approach for the management of STIs.

Characteristics of CT positive participants

Characteristics	Chlamydia infections/n	Prevalence (%)	P value
Age group
<25	1/13	8
25–29	6/28	21
30–34	6/56	11
35–39	10/67	15
40–44	8/48	17
45–49	2/37	5
Marital status
Married	29/211	14	0.59
Not married	4/38	11
Education level
Primary and below	11/67	16	0.37
Above primary	22/182	12
Occupation
Paid employment	11/83	13	0.9
Self employed	16/127	13
Unemployed	6/39	15
Coitarche
≤20 years	21/160	13	0.95
>20 years	10/78	13
Treated STIs
No	32/224	14	0.22
Yes	1/25	4

Full article at:   http://goo.gl/zLt0e0

By:  Maina AN1, Kimani J2, Anzala O3.

• 1Department of Medical Microbiology, University of Nairobi, P.O BOX 19676-00202, Nairobi, Kenya. acnmaina@yahoo.com.
• 2Kenya AIDS Control Project, University of Manitoba/Nairobi Collaborative Research Group, P.O BOX 19676-00202, Nairobi, Kenya.
• 3KAVI Institute of Clinical Research, University of Nairobi, P.O BOX 19676-00202, Nairobi, Kenya.
• BMC Res Notes. 2016 Mar 29;9(1):193. doi: 10.1186/s13104-016-1990-x. 

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Screening for Asymptomatic Gonorrhea and Chlamydia in the Pediatric Emergency Department

BACKGROUND:

Because adolescents rely heavily on emergency services for health care, a pediatric emergency department (PED) visit may be their only opportunity for sexually transmitted infection (STI) screening. The primary objectives of this study were to determine the proportion of Neisseria gonorrheae (GC) and Chlamydia trachomatis (CT) infections in asymptomatic PED adolescents and patient-perceived barriers to STI screening.

METHODS:

A convenience sample of patients aged 14 to 21 years presenting to an urban PED with nongenitourinary complaints was offered screening for GC and CT. Regardless of declining or accepting screening, all were asked to complete a questionnaire designed to identify barriers to screening.

RESULTS:

Sixty-eight percent of those approached participated (n = 719). Those who agreed to STI screening were more likely to be nonwhite (61.4% vs. 38.6%, P = 0.001) and publically insured (63.3%) versus privately insured (29.3%) or no insurance (7.58%). Four hundred three (56%) participants provided urine samples, and of those, 40 (9.9%) were positive for an STI. Controlling for other demographics, race was a significant predictor, with the odds of testing positive for nonwhite participants 5.90 times that of white participants. Patients who refused testing were more likely to report not engaging in sexual activity (54.3% vs. 42.4%, P = 0.009) and less likely to perceive that they were at risk for STIs.

CONCLUSIONS:

There are high proportions of GC and CT among asymptomatic adolescents visiting an academic urban PED. A universal PED STI screening program may be an important component of STI reduction initiatives, especially among adolescents who do not perceive that they are at risk and may not receive testing elsewhere.

Purchase full article at:   http://goo.gl/X4xKlt

By:  Schneider K1, FitzGerald M, Byczkowski T, Reed J.

• 1From the*Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH; and †Division of Pediatric Emergency Medicine, University of Minnesota Children's Hospital, Minneapolis, MN. 
• Sex Transm Dis. 2016 Apr;43(4):209-15. doi: 10.1097/OLQ.0000000000000424.

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HIV Incidence among Men Who Have Sex with Men After Diagnosis with Sexually Transmitted Infections

BACKGROUND:

Men who have sex with men (MSM) are at high risk for acquiring HIV infection after diagnosis with other sexually transmitted infections (STIs). Identifying the STIs associated with the greatest risk of subsequent HIV infection could help target prevention interventions, particularly preexposure prophylaxis (PrEP).

METHODS:

Using matched HIV and STI surveillance data from Washington State from January 1, 2007, to June 30, 2013, we calculated the incidence of new HIV diagnoses after different STI diagnoses among MSM. Men entered observation at the time of their first STI diagnosis during the study period and exited at HIV diagnosis or June 30, 2013. Cox proportional hazards regression was used to conduct a global comparison of rates.

RESULTS:

From January 1, 2007, to June 30, 2013, 6577 HIV-negative MSM were diagnosed as having 10,080 bacterial STIs at 8371 unique time points and followed for 17,419 person-years. Two hundred eighty (4.3%) men were subsequently diagnosed as having HIV infection for an overall incidence of 1.6 per 100 person-years (95% confidence interval, 1.4-1.8). The estimated incidence of HIV diagnoses among all MSM in the state was 0.4 per 100 person-years. Men who have sex with men were at the greatest risk for HIV diagnosis after being diagnosed as having rectal gonorrhea (HIV incidence, 4.1 per 100 person-years), followed by early syphilis (2.8), urethral gonorrhea (1.6), rectal chlamydial infection (1.6), pharyngeal gonorrhea (1.1), late syphilis (1.0), and urethral chlamydial infection (0.6; P < 0.0001 overall).

CONCLUSIONS:

Men who have sex with men diagnosed as having rectal gonorrhea and early syphilis were at the greatest risk for being diagnosed as having HIV infection after STI diagnosis. These men should be prioritized for more intensive prevention interventions, including PrEP.

Below:  Cumulative hazard of HIV diagnosis following bacterial STIs (STI) GC = gonorrhea. CT = chlamydial infection

Below:  Percent of 736 MSM newly diagnosed as having HIV infection from July 2011 to June 2013 with a reported STI diagnosis in the 2 years before HIV diagnosis GC indicates gonorrhea; CT, chlamydial infection.

Full article at:   http://goo.gl/N3Kb5L

By:  Katz DA1, Dombrowski JC, Bell TR, Kerani RP, Golden MR.

• 1From the Departments of *Medicine and †Epidemiology, University of Washington, Seattle, WA; ‡HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and §Infectious Disease Assessment Unit, Washington State Department of Health, Olympia, WA. 
• Sex Transm Dis. 2016 Apr;43(4):249-54. doi: 10.1097/OLQ.0000000000000423.

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Prevalence of HIV, Sexually Transmitted Infections, and Risk Behaviours among Female Sex Workers in Nairobi, Kenya: Results of a Respondent Driven Sampling Study

We conducted a respondent driven sampling survey to estimate HIV prevalence and risk behavior among female sex workers (FSWs) in Nairobi, Kenya. 

Women aged 18 years and older who reported selling sex to a man at least once in the past 3 months were eligible to participate. Consenting FSWs completed a behavioral questionnaire and were tested for HIV and sexually transmitted infections (STIs). Adjusted population-based prevalence and 95 % confidence intervals (CI) were estimated using RDS analysis tool. Factors significantly associated with HIV infection were assessed using log-binomial regression analysis. 

A total of 596 eligible participants were included in the analysis. Overall HIV prevalence was 29.5 % (95 % CI 24.7–34.9). Median age was 30 years (IQR 25–38 years); median duration of sex work was 12 years (IQR 8–17 years). The most frequent client-seeking venues were bars (76.6 %) and roadsides (29.3 %). The median number of clients per week was seven (IQR 4–18 clients). HIV testing was high with 86.6 % reported ever been tested for HIV and, of these, 63.1 % testing within the past 12 months. Of all women, 59.7 % perceived themselves at ‘great risk’ for HIV infection. Of HIV-positive women, 51.0 % were aware of their infection. In multivariable analysis, increasing age, inconsistent condom use with paying clients, and use of a male condom as a method of contraception were independently associated with unrecognized HIV infection. Prevalence among STIs was low, ranging from 0.9 % for syphilis, 1.1 % for gonorrhea, and 3.1 % for Chlamydia. 

The data suggest high prevalence of HIV among FSWs in Nairobi. Targeted and routine HIV and STI combination prevention strategies need to be scaled up or established to meet the needs of this population.

Below:  Respondent driven sampling recruitment profile of female sex workers by Constituency Nairobi, Kenya, 2010

Bivariate and multivariable log-binomial analysis of predictors of unrecognized HIV infection among female sex workers, Nairobi, Kenya, 2010 (N = 480)

Variable	Unadjusted RR (95 % CI)	p value	Adjusted RR (95 % CI)a	p value
Age group (years)
18–24	Referent	–	Referent	–
25–29	1.6 (0.9, 3.1)	.1287	1.5 (0.8, 2.9)	.1808
30–34	2.9 (1.6, 5.2)	.0005	2.4 (1.3, 4.3)	.0030
35–62	2.3 (1.3, 4.1)	.0045	2.1 (1.2, 3.7)	.0124
Marital status
Never married	Referent	–
Previously married	0.9 (0.6, 1.3)	.4210
Currently married	1.3 (0.3, 6.4)	.7720
Education
None/incomplete primary	Referent	–
Completed primary	0.5 (0.3, 0.8)	.0088
Incomplete secondary	0.8 (0.5, 1.5)	.5638
Completed secondary+	0.7 (0.4, 1.3)	.2301
Duration of sex work (years)
4–9	Referent	–
10–14	1.0 (0.6, 1.7)	.9705
15–45	1.3 (0.9, 2.1)	.1997
Sex as a main source of income
No	Referent	–
Yes	0.8 (0.5, 1.4)	.4880
Client-seeking locationsb,d
Bar	1.0 (0.6, 1.5)	.8992
Roadside	0.7 (0.4, 1.1)	.1448
At home	1.8 (1.0, 2.9)	.0299
Rented stall or shed	1.2 (0.67, 2.1)	.5430
Clients called participant	1.3 (0.8, 2.0)	.3165
Other locations	0.8 (0.4, 1.9)	.6605
Number of paying partners (past 7 days)
0–10	Referent	–
11–20	0.9 (0.5, 1.6)	.7278
21–30	0.6 (0.3, 1.2)	.1514
31+	0.2 (0.02, 1.5)	.1119
Consistent condom use with paying partners (past 30 days)
Always	Referent	–	Referent	–
Sometimes/never	1.9 (1.3, 2.8)	.0015	2.1 (1.4, 3.0)	.0001
Condom use with last paying partner
Yes	Referent	–
No	0.8 (0.4, 1.4)	.3788
Number of non-paying sex partner(s) (past 30 days)
None	Referent	–
1	0.6 (0.4, 1.0)	.0613
2+	1.0 (0.6, 1.8)	.9442
Consistent condom use with nonpaying partner(s) (past 30 days)
Always	Referent	–
Sometimes/Never	0.7 (0.4, 1.1)	.1380
Condom use with last nonpaying partner
Yes	Referent	–
No	0.5 (0.2, 0.9)	.0287
Drug use (past 12 months)c,d
Marijuana/bhang	0.8 (0.5, 1.2)	.1981
Khat/miraa	0.8 (0.6, 1.3)	.3871
Heroin	1.3 (0.2, 6.8)	.7721
Injection drug use	1.2 (0.2, 5.9)	.8899
Alcohol consumption
Never	Referent	–
Once a month or less	1.9 (0.9, 3.9)	.0973
2–4 times a month	1.1 (0.4, 2.5)	.8879
2–3 times a week	1.3 (0.7, 2.4)	.4658
4 or more times a week	1.3 (0.7, 2.4)	.4037
Contraception method (past 30 days)c
Any contraception used	1.2 (0.8, 1.9)	.4328
Injection	0.8 (0.5, 1.3)	.3901
Male condom	2.3 (1.6, 3.3)	<.0001	2.5 (1.7, 3.5)	<.0001
Implant	0.5 (0.1, 0.9)	.0322
Pill	0.3 (0.1, 1.0)	.0510
Female condom	0.5 (0.1, 1.8)	.2686
Practice douching
No	Referent	–
Yes	1.1 (0.9, 1.2)	.1315

aAdjusted for all variables or individual categories within variables that were found to be significant at p ≤ .20 or lower in bivariate analysis. Variables found to be significant at the p ≤ .05 are displayed

bRespondents could have selected several client-seeking locations

cRespondents could have used selected several drugs in the past 12 months

dReferent group for multi-response variables were women who did not report the response

Full article at:   http://goo.gl/lCBqtV

By:  Helgar Musyoki, Timothy A. Kellogg, Scott Geibel, Nicholas Muraguri, Jerry Okal, Waimar Tun, H. Fisher Raymond,Sufia Dadabhai, Meredith Sheehy, and Andrea A. Kim

Helgar Musyoki, National AIDS and Sexually Transmitted Infection Control Programme, Ministry of Health, P.O. Box 19361-00202, Nairobi, Kenya;

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