Prevalence of reproductive tract infections and the predictive value of girls’ symptom-based reporting: findings from a cross-sectional survey in rural western Kenya

Abstract

ObjectivesReproductive tract infections (RTIs), including sexually acquired, among adolescent girls is a public health concern, but few studies have measured prevalence in low-middle-income countries. The objective of this study was to examine prevalence in rural schoolgirls in Kenya against their reported symptoms.MethodsIn 2013, a survey was conducted in 542 adolescent schoolgirls aged 14–17 years who were enrolled in a menstrual feasibility study. Vaginal self-swabbing was conducted after girls were interviewed face-to-face by trained nurses on symptoms. The prevalence of girls with symptoms and laboratory-confirmed infections, and the sensitivity, specificity, positive and negative predictive values of symptoms compared with laboratory results, were calculated.ResultsOf 515 girls agreeing to self-swab, 510 answered symptom questions. A quarter (24%) reported one or more symptoms; most commonly vaginal discharge (11%), pain (9%) or itching (4%). Laboratory tests confirmed 28% of girls had one or more RTI. Prevalence rose with age; among girls aged 16–17 years, 33% had infections. Bacterial vaginosis was the most common (18%), followed by Candida albicans (9%), Chlamydia trachomatis (3%), Trichomonas vaginalis (3%) and Neisseria gonorrhoeae (1%). Reported symptoms had a low sensitivity and positive predictive value. Three-quarters of girls with bacterial vaginosis and C. albicans, and 50% with T. vaginalis were asymptomatic.ConclusionsThere is a high prevalence of adolescent schoolgirls with RTI in rural Kenya. Public efforts are required to identify and treat infections among girls to reduce longer-term sequelae but poor reliability of symptom reporting minimises utility of symptom-based diagnosis in this population.Trial registration numberISRCTN17486946.

Trichomonas vaginalis infection among adolescent girls in some secondary schools in Benin city, Edo state, Nigeria

“…Improvement in personal hygiene is more likely to be observed in the urban settings due to access to sexual and reproductive health education from several media as well as the availability of reproductive health services which include treatment and counseling services (15). Girls from the rural settings had the highest prevalence (11.7%) of trichomoniasis when compared with other locations.…”

“…Besides, the main issue concerning trichomoniasis is its relationship with serious health consequences like cancer, adverse pregnancy outcomes, infertility and HIV transmission and acquisition (13,14,19,20,21,22). The undetected and untreated T. vaginalis infection can result in increasing morbidity and infertility among adolescent girls (15). There is a dearth of information on trichomoniasis among adolescent secondary school girls in Edo State, Nigeria.…”

“…The observed difference in prevalence could be attributed to geographical locations, personal hygiene and diagnostic methods used. There is the need to put in place drastic measures otherwise, the high prevalence of T. vaginalisinfection observed in adolescent girls is likely to remain undetected and untreated, causing a rising pool of infection in the local population, increasing morbidity and reducing their fertility as well as increasing their risk of other reproductive tract infection and human immunodeficiency virus (15).…”

“…Complications of this disease in both men and women have been reported and they include increased risk of HIV, premature rupture of membranes, premature labour, pelvic inflammatory disease, low birth weight, infection of the adnexa, endometrium and bartholin glands (in women), prostatitis, balanoposthitis, epididymo-orchitis (in men) and possibly infertility (9,11,12,13,14). It has been reported that T. vaginalisinfection in adolescent girls is likely to remain undetected and untreated, causing increasing morbidity and reducing their fertility as well as increasing their risk of other reproductive tract infection and human immunodeficiency virus (15). This has not been well studied in our locality therefore, this study aimed to determine the prevalence of T. vaginalisinfection among adolescent girls in some secondary schools in Edo State, Nigeria.…”

Adolescent sexual health: time to invest in a healthy future generation

“…The article of Kerubo et al 12 serves as a commendable description of this high burden of reproductive tract infections (RTIs) in 515 rural schoolgirls aged 14–17 years from a Luo population in Kenya and shows that reproductive tract symptoms were reported in 32% of the laboratory confirmed infections (restricted to Trichomonas vaginalis , Chlamydia trachomatis , Neisseria gonorrhoeae , bacterial vaginosis and Candida albicans ). The prevalence of RTIs, excluding C. albicans , was around 24% with nearly a quarter of the infections being identified as an STI.…”