GHENT UNIVERSITY Karoline FONCK - International Centre for ...

In contrast with high overall STI prevalence rates observed among men (self-reported) as
well as women in our various studies, we demonstrated a declining syphilis seroprevalence
rate among pregnant women over the past years in Nairobi. One explanation might be the
massive use of antibiotics among the general population in Nairobi, as by anecdotal
evidence. Antibiotics are freely available and sold by vendors, in markets and in pharmacies
without prescription. But this would not explain the high prevalence rates observed for the
other STIs. Another explanation of this observed downward trend in syphilis serology may be
the relative effective partner notification and treatment for syphilis during pregnancy, as we
described.
However, trends in reported STI cases should be interpreted with caution. Serwadda et al.
(1996) indicated that an observed decrease in HIV prevalence among pregnant women of
2% resulted from a decrease of 4.3% owing to mortality and net out-migration and an
increase of 2.3% owing to new infections. The declining syphilis seroprevalence rates we
observed might have been confounded by several factors: lack of information on patterns of
fertility, on age groups and on pattern of antenatal clinic use.
An important determinant of STI transmission dynamics is the duration of the infection in a
sexually active individual. In our studies, people with symptoms of STI waited long before
attending a health facility. It has been shown that overall women are more likely than men to
seek health care, however care for STIs appears to be an important exception for several
reasons. Women infected with an STI are far more likely to be asymptomatic. When
symptoms do occur, these are generally less clearly attributable to STIs. But even for
women who do recognize the symptoms, presentation to an STI clinic may be too stigmaladen.
An additional issue related to healthcare-seeking involves confidentiality. These
concerns may constitute a serious obstacle to seek medical care.
Condom use was found to be low in general but even more among women. Mathematical
modeling projections showed that the strategy of increasing condom use among women in
steady relationships is the least effective in reducing the incidence of HIV and this in different
profiles of sexual behavior and for different levels of condom use tested. These results are in
line with earlier ones based on more stylized models stressing the importance of reaching
high-risk groups, or the core, in STI prevention. Inconsistent condom use delays but does
not prevent HIV transmission in discordant couples (Van Vliet 2001).
Studies have suggested that one risk factor associated with recurrent STI among women is
continued sexual contact with a partner who failed to be treated (Fortenberry 1995). Another
CONCLUSIONS 101