Abstract
Objectives: Globally, the highest rates of sexually transmitted infections (STIs) are among the 15-24 age group. Studying adolescent girls and young women (AGYW) pre-sexual debut could identify risk factors for STI acquisition.Methods: We recruited a prospective cohort of low-risk AGYW aged 16-20 in Kenya. Participants were HIV and HSV-2 seronegative and reported no history of sexual intercourse or reported sex with one partner. Participants underwent genital exams, nucleic acid testing of vaginal swabs for Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and vaginal gram stains for vaginal dysbiosis by Nugent score. STI correlates were described using χ2 test and t-test.Results: We enrolled 400 AGYW, of which 322 (80.5%) reported never having had sex, while 78 (19.5%) reported prior sex with 1 partner. Among the 78 participants reporting prior sex, 20 (25.6%) reported contraception use in the last 3 months, with 60% using only emergency contraceptive pills. Despite self-reported history, of 373 subjects who underwent STI testing, 49 subjects (13.1%) tested positive for STIs, with 41 CT, 5 GC, and 3 TV cases. Of these 49 subjects, 33 (67.3%) reported no prior sexual intercourse. Bacterial vaginosis was rare and 90% of subjects had a normal Nugent score (0–3).Conclusions: Upon baseline evaluation of a cohort of low risk AGYW, we found high numbers of STIs, especially CT, which is not routinely screened for in Kenyan settings. Interventions to address STIs and unintended pregnancy should target girls pre-sexual debut, including those who do not self-identify as at risk.
Highlights
The World Health Organization estimates there were 376 million new cases of four curable sexually transmitted infections (STIs), chlamydia, gonorrhea, syphilis, and trichomoniasis, in 2016 [1]
Of the 400 participants, 373 had a vaginal swab collected for GC, Chlamydia trachomatis (CT), or Trichomonas vaginalis (TV) testing
Twenty participants did not have a swab collected due to menstruation; 7 did not have a swab collected for other reasons
Summary
The World Health Organization estimates there were 376 million new cases of four curable sexually transmitted infections (STIs), chlamydia, gonorrhea, syphilis, and trichomoniasis, in 2016 [1]. The highest reported rates of STIs are among youth ages 15-24 [2], especially in resource-poor countries [3]. The high prevalence of STIs observed among adolescent girls and young women (AGYW) compared to their male counterparts may be related to increased biological susceptibility, decreased educational, and economic opportunities, older sexual partners, increased risk for sexual coercion, and cultural norms and gender inequalities that reduce access to sexual health resources [6]. The global STI epidemic will increase the burden of long-term health effects of undiagnosed and untreated disease, including pelvic inflammatory disease, infertility, ectopic pregnancy, and increased risk of HIV acquisition [1]. To understand risk factors for STI acquisition present from early adolescence, we enrolled a cohort of AGYW in Kenya to follow them as they transition from virginal to sexually active. We report baseline STI data from the study enrollment visit
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
