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High prevalence of STIs among men engaged in transactional sex and alcohol use in western Kenya: important implications for STI prevention interventions
  1. Sue Napierala1,
  2. Elizabeth F Bair2,
  3. Ouma Dan Omollo3,
  4. Teniola I Egbe2,
  5. Julius Oduor Wesonga3,
  6. Anisha Rajaratnam2,
  7. Connie Celum4,
  8. Harsha Thirumurthy2,
  9. Kawango Agot3
  1. 1Women’s Global Health Imperative, RTI International, Research Triangle Park, North Carolina, USA
  2. 2University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  3. 3Impact Research and Development Organisation, Kisumu, Kenya
  4. 4Department of Global Health, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Sue Napierala; snapierala{at}rti.org

Abstract

Objectives Better data on aetiological prevalence of sexually transmitted infections (STIs) among African men could greatly strengthen STI prevention efforts and convey benefits to women as well. In an ongoing study among men in Kenya, we analysed baseline STI prevalence and individual characteristics associated with STI.

Methods In Siaya County, Kenya, we recruited men aged 18–39 years who self-reported engagement in transactional sex and alcohol use. We administered a baseline questionnaire to participants and conducted testing for HIV, herpes simplex virus type 2 (HSV-2), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection. Characteristics associated with bacterial STIs were analysed using logistic regression and we estimated the positive and negative predictive values (PPV/NPV) of syndromic management of these infections.

Results We enrolled 1500 participants from July 2022 to March 2023. Participant mean age was 27.9 years, 62.2% were married/cohabitating and 53.5% were heavy alcohol users (Alcohol Use Disorders Identification Test-Consumption≥4). Participants reported a mean of 4.2 sexual partners and 3.5 transactional sex partners in the past 3 months. HIV prevalence was 9.5%, HSV-2 was 38.7%, CT was 14.3% and NG was 2.5%. Combined CT and/or NG infection was detected in 16.1% of participants.

Compared with participants uninfected, those testing positive for CT and/or NG were younger (p=0.001), had more sexual partners (p=0.027) and transactional sex partners (p=0.039), were less likely to have used a condom at last sex (p=0.015) and were more likely to self-report having an STI besides HIV in the past 12 months (p=0.002). The PPV and NPV for currently experiencing CT and/or NG symptoms were 33.3% and 84.4%, respectively.

Conclusions Among Kenyan men engaged in transactional sex and alcohol use, STI prevalence was high. These data fill an important gap about STI prevalence and risk factors in African men highlighting the risk of ongoing transmission and the need for targeted prevention programmes and expanded access to testing and treatment.

  • Men
  • Chalmydia Trachomatis
  • Neisseria Gonorrhoeae
  • Risk factors
  • Africa

https://doi.org/10.1136/sextrans-2024-056266

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    Footnotes

    • Handling editor Nadja A Vielot

    • Contributors SN, HT, KA and CC designed the study, with input from EFB and TIE. ODO, JOW and KA implemented the study. EFB and SN analysed the data. SN, EFB and AR wrote the first draft of the manuscript. SN accepts full responsibility for the work, had access to the data and controlled the decision to publish. All authors provided critical review of the manuscript and approved the final version.

    • Funding This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD103563).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.