Grant: Travel Awards - Institute Community Support

Introduction: Female sex workers in sub-Saharan Africa are a key population at risk of HIV acquisition. This risk is increased by inflammation and skin damage in the female genital tract, both of which may be caused by sexually-transmitted infections (STIs). Here we investigate the effect of three STIs on genital protein markers of inflammation among HIV-uninfected Kenyan FSWs. Methods: This study was nested within the Maisha Fiti study, a longitudinal mixed-method study that investigated the impact of violence and mental health problems on genital immunology among FSWs in Nairobi, Kenya. Behavioural and socio-demographic data were collected from 746 HIV-uninfected participants at their baseline visit. Participants were tested for three common STIs (Chlamydia trichomonas, CT; Neisseria gonorrhoeae, NG; Trichomonas vaginalis, TV), while genital secretions were collected by menstrual cup for the quantification of inflammatory protein markers by immune assay. We prospectively evaluated the effect of these STIs on genital inflammation, defined by a clinically validated inflammation score of inflammatory protein markers, in a mixed effects model. Results: The baseline prevalence of CT, GC and TV infection was 64/726 (8.6%), 20/746 (2.7%) and 20/746 (2.7%) participants, respectively. After controlling for potential confounders, CT infection (p=0.034) was associated with genital inflammation, while GC infection (p=0.072) and TV infection (p=0.647) were not. Conclusions: In this unique cohort of Kenyan female sex workers, CT infection was the most common STI detected and had the strongest association with inflammation among the STIs investigated in this study. These findings add upon previous studies that explore the effect of STIs on sexual health, and highlight the need to reduce the prevalence of STI co-infections as a strategy for tackling the HIV pandemic.