High prevalence of sexually transmitted infections among adolescent girls and young women seeking HIV testing in Entebbe, Uganda

Background Adolescent girls and young women (AGYW) in Uganda experience a high burden of sexually transmitted infections (STIs), increasing vulnerability to HIV acquisition. Despite the WHO and Uganda’s Ministry of Health recommendations, routine integration of STI screening into HIV testing services (HTS) remains limited. We assessed the prevalence of laboratory-confirmed STIs, associated factors and Neisseria gonorrhoeae antimicrobial resistance among AGYW seeking HTS in Entebbe, Uganda. Methods We conducted a cross-sectional study among 321 AGYW aged 15–24 years attending HTS at the Uganda Virus Research Institute (UVRI) clinic. Endocervical swabs were tested for N. gonorrhoeae (culture and sensitivity), Trichomonas vaginalis (wet microscopy) and bacterial vaginosis (BV; Nugent scoring). Syphilis was assessed using the Treponema pallidum haemagglutination assay. Modified Poisson regression was used to estimate adjusted prevalence ratios (aPR) for factors associated with any STI. Results Overall STI prevalence was 35.2% (n=113, 95% CI 30.0 to 40.5), with 41.6% (47/113) of infections occurring among asymptomatic individuals, driven largely by BV at 31.5% (100/318), followed by T. vaginalis at 7.3% (23/316), syphilis at 5.0% (16/321) and N. gonorrhoeae at 1.3% (4/318). STI prevalence among AGYW who tested positive for HIV was 47.8% (11/23), while among those who tested negative was 34.2% (102/298). In multivariable analysis, having fewer sexual partners was associated with lower STI prevalence (one partner: aPR 0.07, 95% CI 0.03 to 0.14; 2–3 partners: aPR 0.73, 95% CI 0.58 to 0.90, compared with >3 partners); condom use was associated with lower STI prevalence (aPR 0.62, 95% CI 0.45 to 0.84), and intrauterine device use was associated with higher STI prevalence (aPR 1.61, 95% CI 1.24 to 2.08). Among four N. gonorrhoeae isolates, three showed resistance to ciprofloxacin, and all four were resistant to penicillin G; all were susceptible to cefotaxime. Conclusions A high burden of STIs, including asymptomatic infections, was observed among AGYW seeking HTS in an urban Ugandan setting. These findings support the integration of diagnostic STI screening into HTS.