Kisumu women record increase in STIs despite taking prevention drug
Chlamydia is a common STI.
What you need to know:
- Doxycycline PEP has been proposed as an STI (sexually transmitted infections) prevention strategy to reduce chlamydia, syphilis, and possibly gonorrhea.
- According to the Kenya Medical Research Institute (Kemri), doxycycline PEP is a sexual health strategy in which people who are at high risk of STIs take one 200mg pill of doxycycline, a kind of tetracycline, as soon as possible but no later than three days after having unprotected sex.
Women in Kisumu have recorded a 78 per cent increase in chlamydia infections, with 35 per cent of the infections being among those taking doxycycline post-exposure prophylaxis (doxycycline PEP).
Doxycycline PEP has been proposed as an STI (sexually transmitted infections) prevention strategy to reduce chlamydia, syphilis, and possibly gonorrhea.
According to the Kenya Medical Research Institute (Kemri), doxycycline PEP is a sexual health strategy in which people who are at high risk of STIs take one 200mg pill of doxycycline, a kind of tetracycline, as soon as possible but no later than three days after having unprotected sex.
In addition to low usage of doxycycline, the researchers disclose that antibiotic resistance offers an explanation on why gonorrhea wasn’t also prevented.
“The rate of doxycycline resistant gonorrhea was very high, including 100 per cent of the infections acquired prior to starting the study, “they noted.
This, they say, means that unlike in men, doxycycline taken after unprotected sex does not prevent bacterial STIs.
The researchers, who conducted a 12-month long study since December last year on 449 cisgender women who were taking daily oral HIV pre-exposure prophylaxis (PrEP), found that doxycycline PEP use did not prevent STIs among the women. “18 per cent of participants had an STI at the time they entered the study and over the course of the study ,the rate of STIs remained high – an annual incidence of 27 per cent, which is comparable to rates among men who have sex with men in high income countries.”
According to Prof Elizabeth Bukusi, the principal investigator of the dPEP Kenya Study and senior principal clinical research scientist at Kemri, the results have disappointed not only Kemri researchers but also their partners who include the University of Washington and Hennepin Healthcare Research Institute. “The results from the study are deeply disappointing, and we are committed to understanding why doxycycline PEP wasn’t taken. We are actively working to find ways to support adherence that will work for and can be used by women,” she said.
The findings of the peer reviewed study, which have also been published in the New England Journal of Medicine, have been highly anticipated considering that this is the first study of doxycycline PEP among cisgender women, following multiple studies that showed a high level of STI protection with doxycycline use among cisgender men and transgender women in France and the United States.
“Objective measure of doxycycline detection in hair samples indicate that use of doxycycline was low in this study. Doxycycline PEP needs to be studied further among people assigned female sex at birth. I am hopeful that it will work for everyone regardless of sex and gender, but in our study many women didn’t take the doxycycline they were given. We need STI prevention that is proven, accessible and easy to use.” said Dr Jenell Stewart, dPEP Kenya Study director and Infectious Disease physician at Hennepin Healthcare and University of Minnesota.
“Bacterial STIs in women can lead to lasting and severe consequences including pelvic inflammatory disease, chronic pain, infertility, pregnancy complications and increased susceptibility to HIV. The dPEP Kenya study team continues to understand why use of doxycycline was low and investigate new ways of delivering doxycycline prophylaxis that are acceptable and effective.” Dr Stewart disclosed that she is working with Dr Cherie Blair, assistant professor of Infectious Diseases at University of California, Los Angeles to secure funding for a study of doxycycline prophylaxis against STIs in people assigned female sex at birth.
Their findings come after in April this year scientists at Kemri found two new mutations they say have not been seen before in genes associated with gonorrhea and chlamydia in the country. This came as investigators led by Prof Samson Muuo, the assistant principal research scientist at the Center for Microbiology Research at Kemri, sought to understand why two hospitals in Busia County, which borders Uganda, were recording rising cases of STIs.
They were shocked to find that all 424 Kenyan women aged 15 years and above sampled from the two hospitals tested positive for gonorrhea and chlamydia.
