A recent report highlights a concerning prevalence of sexually transmitted infections (STIs) among adolescents, particularly in informal settlements around Kisumu. The study focused on two common STIs chlamydia and gonorrhea and tested urine specimens from over a thousand adolescents aged 18 to 19 years. It sheds light on the high rates of infection, risk factors, and challenges in accurate diagnosis and treatment.
Researchers collected data from 1,167 adolescents, with many surveyed about their sexual history, perceptions of STI risk, symptoms, diagnosis, and treatment history. The definition of STI symptoms included self-reported abnormal or foul-smelling discharge, lower abdominal pain, painful or burning urination, and genital sores or ulcers. Those who admitted to sexual activity were eligible for urine testing to detect chlamydia and gonorrhea infections.
Among the participants, 423 reported recent sexual activity within the past month, and approximately 715 reported condom use during their last sexual encounter. Despite this, the study found that about one in 100 sexually active adolescents tested positive for either chlamydia or gonorrhea, with a notably higher infection rate among girls. Specifically, 102 tested positive for chlamydia, with 69 girls and 33 boys infected. For gonorrhea, 15 adolescents were positive 13 girls and 2 boys with six individuals (five girls and one boy) testing positive for both infections.
Interestingly, five adolescents who did not report sexual activity during the survey still tested positive for STIs, highlighting challenges related to underreporting due to social stigma around adolescent sexuality. Many adolescents might hesitate to disclose their sexual behavior, even during confidential testing or counseling sessions, which can impede efforts to identify and treat infections effectively.
Kenya currently relies on syndromic management for diagnosing STIs treating based on visible symptoms rather than laboratory testing. However, the study emphasizes that many STIs are asymptomatic, meaning infected individuals may not display obvious symptoms. This reliance on symptom-based diagnosis likely leads to underestimation of STI prevalence and untreated infections. Untreated STIs can cause severe health complications such as pelvic inflammatory disease, infertility, chronic pelvic pain, and increased susceptibility to HIV infection. Additionally, untreated infections may be transmitted to sexual partners or from mother to child during pregnancy and delivery.
The report underscores the importance of laboratory testing for STIs, particularly in adolescent populations where symptom-based diagnosis may miss many infections. Notably, nearly 95% of adolescents offered urine-based testing accepted it, suggesting that self-collected urine samples are a feasible and acceptable method for STI screening in community settings beyond traditional healthcare facilities.
On a global scale, STIs continue to pose a significant public health challenge. The World Health Organization estimates that in 2020, there were 129 million new cases of chlamydia and 82 million new cases of gonorrhea among adults aged 15 to 49. Sub-Saharan Africa carries a disproportionate burden of these infections, accounting for around 40% of the global STI cases. Prevalence rates of chlamydia and gonorrhea among youth in this region range between 7% and 17%, underscoring the urgent need for improved prevention, diagnosis, and treatment strategies.
In efforts to combat gonorrhea, the United Kingdom is exploring the use of an existing vaccine, 4CMenB, originally developed to protect against meningococcal B disease. This vaccine contains proteins from Neisseria meningitidis, a bacterium closely related to Neisseria gonorrhoeae, the cause of gonorrhea. Early studies suggest the 4CMenB vaccine provides partial protection against gonorrhea, reducing infection risk by approximately 33% to 42%. While not completely protective, vaccination could significantly reduce the incidence of gonorrhea and its associated health complications.
The findings from this study highlight the critical need to strengthen STI prevention programs targeting adolescents, particularly in informal settlements where risks are higher. Improving access to accurate diagnostic tools, reducing stigma around adolescent sexual health, and promoting safe sexual behaviors are essential to curbing the spread of STIs and safeguarding the health of young people.
