Hidden disease wreaking havoc on Kenyans fertility

A high number of Kenyans with chlamydia, a sexually transmitted disease, do not receive treatment because they do not know they are infected or the cost of tests is inhibitive.

Untreated chlamydia, Dr Murugi Micheni, of the National Syndemic Diseases Control Council (NSDCC) says, causes infertility and other complications of the reproductive organs.

“It is a hidden disease. About 70 percent of women who have chlamydia may have no symptoms or the symptoms mimic other illnesses or poor hygiene. And this asymptomatic group is what is worrying us,” Dr Murugi says.

Those without symptoms can still infect others through sexual contact, while those with symptoms feel pain while passing urine or in the abdominal area or experience an abnormal discharge or bleeding.

Women can get chlamydia in the cervix, rectum, or throat while in men it manifests in the urethra as well as rectum, or throat.

Laboratory tests can diagnose chlamydia but the tests are expensive, costing about Sh3,150 and Sh17,000 depending on the type of test, and a majority of public hospitals lack laboratories and machines to test the disease.

Of concern is the increasing rates of STDs among youth. In a study done in 2020 on Kenyan youth in Kilifi, more than one in eight girls tested positive for gonorrhea with chlamydia infection being the most common.

“Our research indicates that adolescents and young women can go from sexual naiveté to engaging in sexual intercourse to the acquisition of STIs in a relatively short time frame, indicating a brief window to intervene to reduce risks,” the researchers said in the study dubbed Sexually Transmitted Infections Among Kenyan Adolescent Girls And Young Women With Limited Sexual Experience.

An ailing youth population means that Kenya is staring at a huge medical cost burden in caring for young people. Besides untreated chlamydia heightening the risk of the infections spreading, severe disease is more expensive to treat.

Another concern is lack of accurate data. Because Kenyans with symptoms are opting to buy over-the-counter antibiotics that treat a broad range of symptoms instead of visiting clinics, there is no precise data on the number of Kenyans with the diseases.

“Data on lab-confirmed STD prevalence remains a challenge among these populations,” said Dr Murugi.

Without exact data, Kenya is sitting on a ticking time bomb. Untreated STDs also lead to pelvic inflammatory disease, chronic pain, infertility, and even blindness and death in newborns.

“Sometimes I wonder how many of the infertility cases we’re seeing are caused by untreated chlamydia,” adds Dr Murugi.

It is not just data for the purpose of collecting it. Surveillance of all STDs, is the backbone of public health. Without timely and accurate data, it is like the Health Ministry has blindfolds on, as it tries to figure out the hotspots regions, and age groups.

Another worrying trend, away from the ‘sponsor culture’ seen as fuelling new infections, is sexual concurrency. This is where Kenyans are having serial partners within a network. A man or woman, for instance, has three or more types of sexual relations.

“Our focus now is on sexual networks. We need to see who you relate with within your network. Chances are this person has another partner like you. That is your sexual network. How many people need to have an STI in that network to make everyone sick?” Poses Dr Murugi.

“It usually looks like a stable network, not the serial one-night stands, right? But it just needs one person to do something stupid,” she adds.

Because having STDs is still taboo, stigma runs deep and these diseases are seen to happen to other people but not those within one’s network.

One of the under-the-rugs topics is oral sex and STDs. Oral sex is a widely practiced behaviour among Kenyans, yet there is no local research or the conversations are low-tone on behaviours associated with sexually transmitted infections of the pharynx (throat).

In a study done on gonorrhea in the throat among young people, researchers said the recent spike in the prevalence of STDs in the US highlights the need for a better understanding of the risks of throat infections.

The study found that throat gonorrhea was relatively common among young people.

The researchers say counselling, education, and screening should be broadened to include gonorrhea, chlamydia, and other STDs occurring in the throat.

“Young people and those most at risk for these infections could be made aware of the potentially heightened risk for gonorrhea from swallowing fluids. There is also evidence of the preliminary efficacy and acceptability of the use of antiseptic mouthwash for the prevention of pharyngeal gonorrhea,” the researchers said.

Dr Joan Okemo, a consultant in obstetrics and gynaecology at Aga Khan University Hospital, Nairobi, says among teenagers, oral sex is preferred as a way of avoiding pregnancies and some believe it is a risk-free practice.

“Several disease-causing bugs can be passed through oral sex including intestinal parasites, bacteria, syphilis, herpes, gonorrhea, chlamydia, Hepatitis A, B and C, and HPV which is responsible for warts and some cancers such as cervical and throat cancers,” she said.

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