title: High prevalence of sexually transmitted infections in pregnant adolescent girls in Tanzania: a multi-community cross-sectional study.
abstract: BACKGROUND
  Limited data document sexually transmitted infections (STIs) among pregnant adolescents in sub-Saharan Africa, where prenatal screening typically includes only HIV and syphilis. Given that HIV incidence in this population is among the world's highest, we sought to assess the prevalence and factors associated with STIs in a population of rural pregnant adolescents in Tanzania.
  
  
  METHODS
  We enrolled 403 pregnant adolescent girls from 10 antenatal clinics near Mwanza, Tanzania. Girls answered structured interviews about sexual health and risk factors and were tested for six common STIs.
  
  
  RESULTS
  199 girls (49.4%) had at least one STI. Herpes Simplex Virus- Type 2 was most prevalent (139 girls, 34.5%), followed by trichomoniasis (54 girls, 13.4%), chlamydia (46 girls, 11.4%), gonorrhoea (27 girls, 6.7%), syphilis (21 girls, 5.2%) and HIV (30 girls, 4.7%). Of note, 53/199 (26.6%) of girls with laboratory-proven STIs were asymptomatic. On multivariable analysis, the presence of any STI was associated with being in a long-term (as opposed to short-term) relationship (OR=2.6 (1.4 to 4.9) p=0.004), younger age at first sexual debut (OR=0.9 per year (0.8 to 0.99), p=0.034), increasing age difference between the girl and her partner (OR=1.1 (1.0 to 1.1) per year, p=0.03) and history of prior pregnancy (OR=1.6 (1.0 to 2.6), p=0.04).
  
  
  CONCLUSIONS
  STIs affected half of rural pregnant adolescents in Tanzania. Our work demonstrates the urgent need to incorporate routine STI testing into antenatal care in Tanzania to prevent morbidity and mortality in young girls and their babies. We also identify behavioural and demographic risk factors that can be used to target interventions to those at highest risk.
authors.affiliation: Department of Pediatrics, Bugando Medical Centre, Mwanza, Tanzania Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Adolfine
authors.initials: A
authors.lastname: Hokororo
authors.affiliation: Catholic University of Health and Allied Sciences, Mwanza, Tanzania Department of Obstetrics and Gynecology, Bugando Medical Centre, Mwanza, Tanzania.
authors.forename: Albert
authors.initials: A
authors.lastname: Kihunrwa
authors.affiliation: Vrije Universiteit, Amsterdam, the Netherlands.
authors.forename: Pytsje
authors.initials: P
authors.lastname: Hoekstra
authors.affiliation: Catholic University of Health and Allied Sciences, Mwanza, Tanzania Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Kalluvya
authors.affiliation: National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: John M
authors.initials: JM
authors.lastname: Changalucha
authors.affiliation: Department of Medicine, Center for Global Health, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
authors.affiliation: Catholic University of Health and Allied Sciences, Mwanza, Tanzania Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania Department of Medicine, Center for Global Health, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Downs
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015995:Prevalence; D012424:Rural Population; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
references.citation: Pediatrics. 2001 Aug;108(2):223-9
references.pmid: 11483781
references.citation: Lancet. 2009 Sep 12;374(9693):881-92
references.pmid: 19748397
references.citation: J Clin Microbiol. 1991 Feb;29(2):297-301
references.pmid: 1706728
references.citation: PLoS Med. 2013 Nov;10(11):e1001545
references.pmid: 24223524
references.citation: BMC Pregnancy Childbirth. 2007;7:5
references.pmid: 17456230
references.citation: AIDS. 2002 Feb 15;16(3):451-62
references.pmid: 11834958
references.citation: BMC Public Health. 2011;11:490
references.pmid: 21696581
references.citation: AIDS Care. 1998 Oct;10(5):571-82
references.pmid: 9828954
references.citation: Reprod Health Matters. 2013 May;21(41):97-105
references.pmid: 23684192
references.citation: Acta Paediatr. 2015 Dec;104(12 ):1291-7
references.pmid: 25473729
references.citation: Am J Obstet Gynecol. 2002 May;186(5):918-20
references.pmid: 12015513
references.citation: Trop Med Int Health. 2001 Jul;6(7):517-25
references.pmid: 11469944
references.citation: East Afr Med J. 2002 Jan;79(1):16-21
references.pmid: 12380865
references.citation: J Clin Microbiol. 2013 May;51(5):1611-3
references.pmid: 23486714
references.citation: JAMA. 2003 Jan 8;289(2):203-9
references.pmid: 12517231
references.citation: Int J Gynaecol Obstet. 2007 Nov;99 Suppl 1:S98-107
references.pmid: 17868676
references.citation: Health Educ Res. 2007 Aug;22(4):483-99
references.pmid: 17018766
references.citation: Arch Sex Behav. 2011 Feb;40(1):5-15
references.pmid: 20652390
references.citation: BMC Infect Dis. 2008;8:75
references.pmid: 18513451
references.citation: Sex Transm Infect. 2005 Aug;81(4):294-302
references.pmid: 16061534
references.citation: Contraception. 2011 Feb;83(2):95-8
references.pmid: 21237332
references.citation: J Infect Dis. 1991 Sep;164(3):588-91
references.pmid: 1869844
references.citation: Pediatrics. 1984 Jun;73(6):836-40
references.pmid: 6547226
references.citation: N Engl J Med. 1991 May 2;324(18):1247-52
references.pmid: 1849612