Prevalence of and risk factors for sexually transmitted infections among women attending family planning clinic at Kenyatta national hospital, Nairobi

Abstract

Background Sexually Transmitted Infections (STIs) are a major public health problem, especially in developing countries. The complications of untreated STIs in the female genital tract and their role in adverse pregnancy and perinatal outcomes have been well documented. However, most infections are asymptomatic and screening, especially for women in the reproductive age group is recommended. The prevalence of STIs in Kenya among women in the general population has not been extensively studied and there is a lack of guidelines for screening of nonpregnant women. Knowledge of the prevalence of curable STIs among this population can provide a basis for integrating STI screening in family planning clinics. Objective: To determine the prevalence and the risk factors for three curable sexually transmitted infections among women attending family planning clinic at Kenyatta National Hospital. Methodology: A cross-sectional study was conducted between May and September 2013 at the Family Planning (FP) clinic at Kenyatta National Hospital. A total of 261 participants were enrolled with data from 249 participants being analysed. An interviewer-administered questionnaire was used to gather socio-demographic data and assess for risk factors. Two endocervical swabs were collected from each participant and used to screen for Trichomonas vaginalis using the wet mount procedure; to culture for Neisseria gonorrhoeae and to conduct PCR for Chlamydia trachomatis. Results: A total of 249 women aged between 20 – 49 years were tested. The prevalence of Chlamydia trachomatis was 13.3%, Trichomonas vaginalis 0.4% and Neisseria gonorrhoeae 0%. All the infected women reported having had only one partner in the previous year. The 13 age group prevalence for Chlamydia trachomatis was highest in the 35 – 39 years age group (30.3%). Married participants were associated with higher infection rate (91%) than single participants (3.03%) and an age of coitarche of less than 20 years was associated with increased risk of Chlamydia infection. Conclusion: A high prevalence of Chlamydia trachomatis was identified among women, majority of whom were married, attending the Family Planning Clinic at Kenyatta National Hospital. The prevalence of Neisseria gonorrhoeae and Trichomonas trachomatis was however found to be low. The study reinforces the need to implement regular screening for STIs among FP clinic attendants. It also reveals the need to review the usage of the syndromic approach for the management of STIs as it showed a low specificity and positive predictive value when symptoms were compared to the gold standard of CT PCR