title: Prevalence of reproductive tract infections and the predictive value of girls' symptom-based reporting: findings from a cross-sectional survey in rural western Kenya.
abstract: Reproductive tract infections (RTIs), including sexually acquired, among adolescent girls is a public health concern, but few studies have measured prevalence in low-middle-income countries. The objective of this study was to examine prevalence in rural schoolgirls in Kenya against their reported symptoms.
  
  
  
  In 2013, a survey was conducted in 542 adolescent schoolgirls aged 14-17 years who were enrolled in a menstrual feasibility study. Vaginal self-swabbing was conducted after girls were interviewed face-to-face by trained nurses on symptoms. The prevalence of girls with symptoms and laboratory-confirmed infections, and the sensitivity, specificity, positive and negative predictive values of symptoms compared with laboratory results, were calculated.
  
  
  
  Of 515 girls agreeing to self-swab, 510 answered symptom questions. A quarter (24%) reported one or more symptoms; most commonly vaginal discharge (11%), pain (9%) or itching (4%). Laboratory tests confirmed 28% of girls had one or more RTI. Prevalence rose with age; among girls aged 16-17 years, 33% had infections. Bacterial vaginosis was the most common (18%), followed by Candida albicans (9%), Chlamydia trachomatis (3%), Trichomonas vaginalis (3%) and Neisseria gonorrhoeae (1%). Reported symptoms had a low sensitivity and positive predictive value. Three-quarters of girls with bacterial vaginosis and C. albicans, and 50% with T. vaginalis were asymptomatic.
  
  
  
  There is a high prevalence of adolescent schoolgirls with RTI in rural Kenya. Public efforts are required to identify and treat infections among girls to reduce longer-term sequelae but poor reliability of symptom reporting minimises utility of symptom-based diagnosis in this population.
  
  
  
  ISRCTN17486946.
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya.
authors.forename: Emily
authors.initials: E
authors.lastname: Kerubo
authors.affiliation: Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA.
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya.
authors.forename: Newton
authors.initials: N
authors.lastname: Otecko
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya.
authors.forename: Collins
authors.initials: C
authors.lastname: Odhiambo
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Mason
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nyothach
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya.
authors.forename: Kelvin O
authors.initials: KO
authors.lastname: Oruko
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Bauman
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Vulule
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Kisumu, Kenya.
authors.forename: Clement
authors.initials: C
authors.lastname: Zeh
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Penelope A
authors.identifier: 0000-0003-1018-116X
authors.initials: PA
authors.lastname: Phillips-Howard
mesh_terms: D000293:Adolescent; D002690:Chlamydia Infections / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D015995:Prevalence; D015203:Reproducibility of Results; D060737:Reproductive Tract Infections / Q000175:diagnosis* / Q000453:epidemiology*; D012423:Rural Health / Q000706:statistics & numerical data*; D012424:Rural Population; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D014247:Trichomonas Vaginitis / Q000453:epidemiology; D014626:Vaginal Smears / Q000379:methods*; D016585:Vaginosis, Bacterial / Q000453:epidemiology; D016387:Women's Health
keywords: ADOLESCENT; AFRICA; DIAGNOSIS; REPRODUCTIVE HEALTH; SEXUAL HEALTH
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