One in four women has chlamydia

A rise in sexually transmitted infections has been reported in Kenya as the country continues to experience an acute shortage of condoms.

According to the Kenya Medical Research Institution (KEMRI), one out of 4 women suffer from chlamydia.

In 2020, 82.4 million people were newly infected with gonorrhoea globally. 7.1 million adults were infected with syphilis in 2020, globally.

Failure to use condoms highly risks transmission of HIV, other sexually transmitted diseases and unintended pregnancies.

Kenya's condom program is heavily donor-funded, requiring Sh1,117,850,400 with a resource gap of Sh803,235,120 (71.9%) in 2021.

To ensure that every sexually active person in Kenya has access to a sustained supply of quality condoms, correct knowledge, skills and motivation to use them correctly and consistently to prevent transmission of HIV and other sexually transmitted diseases and unintended pregnancies.

Sharon Ngema from Aids Health Care Foundation Kenya (AHF) says advocating for safe sex is their main agenda. Since young people are having sex sensitization should be paramount.

"I know young people love sex, it's like a basic need. That is why we are advocating for safe sex. Anytime you have sex make sure you wrap it," she says.

During the Maisha Conference in Mombasa, National Syndemic Disease Control Council (NSDCC) CEO Dr Ruth Masha said the most sexually active partners say condoms are so expensive. This sometimes is mistaken, when talking about funding.

People would rather go for the most expensive alcohol but not condoms. Dr Masha adds that data is not talking about condoms not being available. Even if available, the use has been low. People do not use condoms, yet they have multiple partners.

"I received a call from a devolution conference notifying me of a shortage of condoms, and on a mission finding, I called one of the supermarkets only to find out they have supplies. Yes, we have a shortage of free condoms, but we have commercial ones in the market," says Masha

Victor Ololo, a counsellor from AHF Kenya, says that the condom shortage led them to have a partnership with the Ministry of Health through the County government's health departments to supply condoms for free.

"There is a shortage of condoms, as AHF Kenya we supply condoms for free but the taxes are too high, so we hope they can remove the taxes so that we can prevent diseases that can be protected with condoms," he says.

Allergic to condoms

The Nairobian asked four young people between the ages of 20-30 about their condom usage.

Maryline Awuor A 20-year-old from Nairobi said that she is allergic to condoms.

"I get itchy and I can't stop having sex because of some allergy. So I just limit my sexual partners and I have the HIV kit at home," she says

Brian Kariuki, a 30-year-old man from Mombasa, said he cannot have sex without a condom.

"I love sex; I do not have one partner. If we click, and there are sexual vibes, let's do it, but with a condom. If she doesn't want then that's it, I will leave," he says.

26-year-old Stacy Chao and 27-year-old Maxwell Musyoki say that they use condoms when the relationship is new then when they decide to be exclusive they stop using condoms.

"Sometimes we get tested before going condom free and sometimes we don't," says Chao.

A total of 190, 110, 760 male condoms were distributed in 2021 against a need of 424 million male condoms. Another 3, 090, 000 million female condoms were distributed in 2021 against a need of 8,206, 345 female condoms. Individual men need 14.6 condoms per year against a global target of 40 condoms per man per year.

45 per cent of males between the ages of 15-49 years use condoms, while 24 per cent of females aged between 15-49 use condoms.

Chlamydia

The average number of sexual partners is 2.3 among women and 7.4 among men. The frequency of chlamydia has surpassed syphilis and gonorrhoea. This is according to Felix Mogaka, a clinical lead research scientist at Kemri - Research Care and Training Programme (KEMRI-RCTP) in Kisumu.

"Unprotected sex is highly contributing to chlamydia, a disease that may end up making our population infertile," said Dr Mogaka.

A report from Kisumu indicates that the disease is common among individuals who use Pre-exposure prophylaxis (PreP), after having unprotected sex.

PreP is an antiretroviral medication for HIV-negative people, which reduces the risk of HIV acquisition.

Chlamydia has no symptoms, and doctors rely on symptoms so most patients get to the hospital when the disease is at an advanced stage.

"Chlamydia is much higher than gonorrhoea and syphilis. Most people do not know about chlamydia because when people hear about STIs, they think about gonorrhoea and syphilis, but actually chlamydia is the most common STI,"

Dr Mogaka said that chlamydia has significant complications, one of them being chronic abdominal pain and infertility.

The study carried out in Kisumu noted that women bear the highest burden of morbidity and mortality from bacterial STIs namely chlamydia trachomatis, Neisseria gonorrhoea, and Treponema pallidum.

For men and transgender women taking HIV PrEP with high rates of STIs, doxycycline post-exposure prophylaxis (PEP) significantly reduced incidents of STIs.

Additionally, women taking HIV PrEP also have a high incidence of bacterial STIs namely trachomatis (27 to 53 per cent per year) and gonorrhoea (11 to 20 per cent per year).

At least 449 non-pregnant women who participated in the study aged between 18 and 30 years were taking HIV PrEP, during the study period conducted in 2022.

In the study, men and transgender women taking HIV PrEP with high rates of STIs, doxycycline PEP significantly reduced the incidence of STIs.

At least 28.4 per cent of participants during the survey reported zero sexual exposure, whereas at least 17.5 per cent had two sexual partners and 28.1 per cent had three partners.

There was also self-reported prep use among participants, after participating in illicit sex. "13 per cent self-reported PrEP discontinuation," reads a section of the study.

There was also no incident of HIV, among participants, after the use of PreP.

"People use PreP because they are not using condoms, having identified already being at risk after sex. This is why we have a high burden of sexually transmitted diseases and infections," explained Mogaka.

Preventive options

In the study, scientists emphasized the need for STI-preventive options for women that are effective and acceptable.

Also, they noted that adherence to preventive medicines needs to be better understood and supported for biomedical prevention to be effective.

Globally, doctors use antibiotics to prevent chlamydia disease, which is yet to be adopted in Kenya as it is expensive.

Mogaka said scientists are pushing for the adaption of point-of-care tests, to test and treat sexually transmitted diseases.

"For smooth treatment of STIs, we need to adopt a technology whereby someone comes in, and they can be tested and given their results within that consultation and treated.," said the researcher.

He added that there is a need to integrate STI testing and treatment into other platforms which people go to access services like family planning clinics and pharmacists.

In Kenya, he observed that most people go to pharmacists as their first point of contact when they have an issue.

"Pharmacists can do testing and treat. We need to spread the services out so that they can be accessed by everyone planning clinics, STI testing clinic," said Dr Mogaka.

Common STIs within the Kenyan population according to the ministry include gonorrhoea, syphilis, chlamydia, and mycoplasma genitalium.

There are also, other sexually transmitted infections, including bacteria trichomonas vaginalis trichomoniasis and Vulvovaginal candidiasis, but have no consequences.

Over the years, it has been established that young people fear pregnancy more than STIs. This has been backed by the increase in the purchase of over-the-counter birth control pills.