Background: Sexually transmitted infections (STIs) are common worldwide, although data on STI prevalence are often lacking for settings in Africa due to limited diagnostic resources. For women interested in initiating pre-exposure prophylaxis (PrEP) for HIV prevention, diagnosis of an STI is a potential marker for HIV risk and treatment can reduce onward STI transmission as well as HIV risk.
Methods: The Prevention Options for Women Evaluation Research (POWER) Cohort is an open label PrEP implementation project for sexually active HIV-negative women ages 16-25 in Cape Town and Johannesburg, South Africa and two clinics in Kisumu, Kenya. PrEP is delivered in accordance with national guidelines; nucleic acid amplification testing for gonorrhea and chlamydia is conducted at baseline and if positive, national standard of care treatment provided.
Results: To date, 330 women have enrolled, of whom 300 (91%) women accepted PrEP. Median age was 20.5 years. Most women (86%) were unmarried and 17% reported having more than one current sex partner. A third of women (34%) tested positive for a curable STI (29% Chlamydia trachomatis and 11% Neisseria gonorrhoeae, with 6% having both infections). STI prevalence was high at all sites: 40% and 16% at the two clinics in Kisumu, 38% in Cape Town, and 35% in Johannesburg (Table). Younger women were significantly more likely to have an STI than older women (53% prevalence among ages 16-17 years, 39% ages 18-21, and 22% ages 22-25, p< 0.01). Only 5.5% of women reported symptoms of an STI at the time of testing.
Conclusions: Young women in Kenya and South Africa participating in a PrEP implementation project had high prevalence of gonorrhea and chlamydia, a marker of high HIV risk as well as a cause of adverse reproductive health consequences. Interventions for STI prevention, diagnostic testing, and optimized treatment for young women are urgently needed.