High prevalence of sexually transmitted infections among women screened for a contraceptive intravaginal ring study, Kisumu, Kenya, 2014

Prevalence and risk factors of sexually transmitted infections in the setting of a generalized HIV epidemic-a population-based study, western Kenya

BACKGROUND

Sexually transmitted infections (STIs) cause adverse health outcomes, including increasing HIV acquisition/transmission risk. We analyzed data from an HIV biomarker and behavioral survey to estimate STI prevalence, and explore associated factors in the setting of a generalized HIV epidemic in Siaya County, western Kenya.

METHODS

Data were collected in March-September 2022 through face-to-face interviews using structured questionnaires; records from 9643 sexually active participants aged 13+ years were included in the analysis. We calculated weighted self-reported STI prevalence, by sex, age, and HIV status and explored associated factors using multivariable logistic regression.

RESULTS

Median age was 37 years and 59.9% were female; HIV prevalence was 18.0%. Overall STI prevalence was 1.8%; 1.5-fold higher among males vs. females, and 2.6-fold higher among participants living with HIV vs. those without. HIV status and multiple sexual partners were independently associated with STI in both sexes. Mind-altering substance use and being circumcised were associated with STI among males.

CONCLUSIONS

This study estimates STI prevalence in the setting of high HIV prevalence. Findings underscore the importance of: effective STI screening in HIV clinics and HIV testing and counseling in STI clinics; screening and counseling on substance use, and HIV pre-exposure prophylaxis; and intensive sexual health counseling in male circumcision programmes.

Antimicrobial resistance patterns in Neisseria gonorrhoeae among male clients of a sexually transmitted infections clinic in Kisumu, Kenya

Approximately 11.4 million cases of gonorrhea occur in the WHO African Region annually and global incidence has been increasing. We sought to determine the distribution and types of antimicrobial resistance in Neisseria gonorrhoeae (NG) in Kisumu, Kenya. Urethral swab specimens were obtained from men attending Universities of Nairobi, Illinois, and Manitoba sexually transmitted infection clinic with urethral discharge detected on clinical exam between 29 January and 2 July 2018. Gonorrhea was confirmed by culturing on Thayer–Martin GC Culture selective media. Disk diffusion was used to measure resistance to antimicrobials. Of the 138 males with history of urethral discharge or dysuria or urethral discharge on exam identified during the surveillance period, urethral swab samples were obtained from 60 men, and 35 (58%) were culture positive. Interpretation of the disk diffusion results showed high resistance (% of isolates) to: penicillin (97%), tetracycline (100%), ciprofloxacin (100%), and doxycycline (91%). All isolates were susceptible to ceftriaxone (100%) and azithromycin (100%). We observed high rates of resistance to several drug classes, likely driven by background selective pressure, as resistance was not observed among currently recommended Kenyan therapies for urethritis. Expanded surveillance for antimicrobial resistance in NG is warranted. Agar dilution or Etest reference testing is needed for accurate assessment of resistance.