The African region is estimated to have the highest prevalence of gonorrhoea globally with a prevalence of 1.9% (95% UI: 1.3–2.7) in women and 1.6% (95% UI: 0.9–2.6) in men. Chlamydia prevalence estimates among 15–49 year olds in the African region are the second highest globally at 5.0% (95% UI: 3.8–6.6) in women and 4.0% (95% UI: 2.4–6.1) in men. In 2016, there were an estimated 127.2 million (95% uncertainty interval (UI): 95.1–165.9 million) chlamydia and 86.9 million (95% UI: 58.6–123.4 million) gonorrhoea infections globally, with prevalence varying by World Health Organization (WHO) region. Importantly both chlamydia and gonorrhoea are curable with well-tolerated short-course antibiotics. These conditions have important sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, infertility, enhanced HIV transmission, and psychological effects. At a cut-point of 19 one in six young people with STIs would be missed.Ĭhlamydia trachomatis and Neisseria gonorrhoeae are the most common bacterial sexually transmitted infections (STIs) worldwide.
The high prevalence of STIs among youth, even in those with no or one reported risk factor, may preclude the use of risk prediction tools for selective STI testing. Two cut-points were chosen: (i) 23 for optimised sensitivity (75.9%) and specificity (59.3%) and (ii) 19 to maximise sensitivity (82.4%) while keeping efficiency at < 60% (59.4%). The STI risk prediction score including those variables ranged from 2 to 46 with an area under the ROC curve of 0.72 (95% CI 0.68, 0.76). CT/NG positivity was independently associated with being female, number of lifetime sexual partners, relationship status, HIV status, self-assessed STI risk and past or current pregnancy. Resultsįrom 3 December 2019 to 5 February 2020, 1007 individuals opted for STI testing, of whom 1003 (99.6%) completed the questionnaire. Sensitivity, efficiency and number needed to screen were calculated for different cut-points. A maximum likelihood Receiver Operating Characteristics (ROC) model was fitted, with the continuous variable score divided into 15 categories of equal size. Coefficients of variables included in the final multivariable model were multiplied by 10 to generate weights for a STI risk prediction tool. Backwards-stepwise logistic regression was performed with p ≥ 0.05 as criteria for exclusion.
The outcome was positivity for either CT or NG. All individuals accepting STI testing completed an STI risk factor questionnaire.
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This study offered CT/NG testing as part of a cluster-randomised trial of community-based delivery of sexual and reproductive health services to youth aged 16–24 years in Zimbabwe.
This study aimed to develop a prediction tool with a sensitivity of > 90% and efficiency (defined as the percentage of individuals that are eligible for diagnostic testing) of < 60%. In the absence of affordable point-of-care STI tests, WHO recommends STI testing based on risk factors. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common bacterial sexually transmitted infections (STIs) worldwide.
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