High prevalence of curable sexually transmitted infections among pregnant women in a rural county hospital in Kilifi, Kenya

Abstract

BackgroundWomen attending antenatal care (ANC) in resource-limited countries are frequently screened for syphilis and HIV, but rarely for other sexually transmitted infections (STIs). We assessed the prevalence of curable STIs, defined as infection with either Chlamydia trachomatis or Neisseria gonorrhoeae or Trichomonas vaginalis, from July to September 2015.MethodsIn a cross-sectional study, women attending ANC at the Kilifi County Hospital, Kenya, had a urine sample tested for C. trachomatis/N. gonorrhoeae by GeneXpert® and a vaginal swab for T. vaginalis by culture. Bacterial vaginosis (BV) was defined as a Nugent score of 7–10 of the Gram stain of a vaginal smear in combination with self-reported vaginal discharge. Genital ulcers were observed during collection of vaginal swabs. All women responded to questions on socio-demographics and sexual health and clinical symptoms of STIs. Predictors for curable STIs were assessed in multivariable logistic regression.ResultsA total of 42/202 (20.8%, 95% confidence interval (CI):15.4–27.0) women had a curable STI. The prevalence was 14.9% for C. trachomatis (95% CI:10.2–20.5), 1.0% for N. gonorrhoeae (95% CI: 0.1–3.5), 7.4% for T. vaginalis (95% CI:4.2–12.0), 19.3% for BV (95% CI: 14.1–25.4) and 2.5% for genital ulcers (95% CI: 0.8–5.7). Predictors for infection with curable STIs included women with a genital ulcer (adjusted odds ratio (AOR) = 35.0, 95% CI: 2.7–461.6) compared to women without a genital ulcer, women who used water for cleaning after visiting the toilet compared to those who used toilet paper or other solid means (AOR = 4.1, 95% CI:1.5–11.3), women who reported having sexual debut ≤ 17 years compared to women having sexual debut ≥18 years (AOR = 2.7, 95% CI:1.1–6.6), and BV-positive women (AOR = 2.7, 95% CI:1.1–6.6) compared to BV-negative women.ConclusionOne in five women attending ANC had a curable STI. These infections were associated with genital ulcers, hygiene practices, early sexual debut and bacterial vaginosis.

Prevalence And Associated Risk Factors Of Bacterial Vaginosis Among Pregnant Women In Africa: A Systematic Review

“…The overall cumulative prevalence of BV in 13 studies conducted in the eastern part of Africa among all pregnant women was about 23.8%, which have the intermediate prevalence of BV in the African region (Table 1), with the highest prevalence of BV was reported from Kenya 52% [17] then followed from Sudan 49.8% [24]. In Ethiopia, the prevalence of BV among all pregnant women (symptomatic and asymptomatic) ranges from 0.5% to 19.4 [25,26] with the cumulative prevalence of 13.8%, whereas in Kenya including HIV infected pregnant women ranges from 19.4-52% [13,17] with the highest cumulative of 29%.…”

“…In Ethiopia, a study conducted in Felegehiwot referral hospital, on Common causes of vaginal infections and antibiotic susceptibility of aerobic bacterial isolates in women of reproductive age(pregnant and nonpregnant), reported that BV was higher among non-pregnant women (11/195, 5.6%) than pregnant women(1/214, 0.5%) and signi cant association was seen in the age group of 40-49 years [25]. [29,37] Marital status 2 [21,29] Multiple LTSP 2 [20,26] Gestational age 1 [32] Residence 1 [25] Number of pregnancy 1 [30] History of abortion 2 [21,26] Preterm delivery 1 [14] Low birth weight 1 [14] premature rupture of membranes 1 [14] Previous BV/STI 3 [13,20,21] Douching 1 [13] Vaginal discharge 2 [29,30] Contraceptive use 1 [23] HIV 6 [11,17,27,32,36,38] [31] .…”

“…Risk factors signi cantly associated with BV were; HIV [11,17,27,32,36,38] (Table 2), age [25,29,30], previous BV/STI [13,20,21], history of abortion [21,26], number of LTSP [20,26], gestational age [32] and douching [13]. Whereas complications associated with BV were also Preterm delivery, Low birth weight, and premature rupture of membranes [14].…”

“…Whereas complications associated with BV were also Preterm delivery, Low birth weight, and premature rupture of membranes [14]. Among pregnant women with a history of STI signi cantly associated with BV were; HSV-2 [21], polygamist (multiple sexual partners) [20], and genital ulcer [13]. And women who used water for cleaning after visiting the toilet were vulnerable to BV as compared to those who used toilet paper or other solid means [13].…”

“…In Kenya, one out of ve pregnant women attending antenatal care clinics (ANC) has a curable, sexually transmitted infection (STIs). These infections are also associated with genital ulcers, hygiene practices, early sexual debut, and bacterial vaginosis [13].…”