To determine the prevalence of 18 sexually transmitted infections (STI) among 18-65 year old women living in the rural North Tongu District in Ghana.
This population-based study included 2000 women who were representatively selected by geographical distribution and invited to self-collected vaginal samples (Evalyn brush, Rovers). Extracted DNA was tested for 18 STIs by multiplex PCR followed by Luminex bead-based hybridization (STIP Assay, Schmitt et al., 2014, J Infection 69:123).
1937/2000 samples collected during the ACCESSING study had sufficient DNA quality and were eligible for STI analyses. The median age of the study population was 30 years. The most prevalent infectious agents were Gardnerella vaginalis (53.7%), Atopobium vaginae (49.1%) and Mycoplasma hominis (33.7%), all known to be associated with bacterial vaginosis (BV). Using a scoring system (according to Schmitt et al. 2014), 24.4% (472/1937) of the women showed a strong or very strong indication for BV. Ureaplasma parvum and Ureaplasma urealyticum were detected in 50.1% (971/1937) and 30.5% (591/1937) of the samples, respectively. Chlamydia trachomatis, causing pelvic inflammatory disease, was detected in 4.9% (94/1937; 95% CI: 4.0% to 5.9%) of the women and Neisseria gonorrhoeae in 2.5% (48/1937). Trichomonas vaginalis showed a prevalence of 4.1% (79/1937) and Treponema pallidum was detected in one sample only.
Data for BV is very rare in the literature and therefore the prevalence of the infectious agents causing BV along with its scoring system provide a first insight into the estimated prevalence in Ghana. Prevalence reported for WHO African Region for Neisseria gonorrhoeae with 2.3% is similar to what we found in our study population. On the contrary WHO reports a prevalence of 2.6% for Chlamydia trachomatis, i.e. 2.3% lower than our data. This difference is statistically significant (p-value < 0.0001). This could possibly be due to the relatively young age group with a median age of 30 years in our study. Treponema pallidum with only one case is below the WHO reported prevalence of 3.5%. This differences could be due to the acutely infected vaginal sample used for our analysis, compared to anamnestic serum samples used for the detection of Treponema pallidum in many studies.
The rare estimates of STI prevalence in developing countries published in the literature represent a contrast to the high burden of disease associated with STIs. Therefore, this data is of great importance. At the same time it highlights the urgent need for further research in this field, due to varying prevalence rates seen, to guide future public health policy.