Prevalence Of Neisseria Gonorrhoeae And Chlamydia Trachomatis And Antibiotic Susceptibility Patterns Among Family Planning Clients At Kenyatta National Hospital, Reproductive Health Clinic.

Abstract

Sexually transmitted infections are common among women of the reproductive age in Kenya (Chlamydia, gonorrhoeae, syphilis, and trichomoniasis). We do not routinely screen for these infections. Despite their public health importance, the focus on HIV/AIDS in the last 10-15 years has overshadowed the importance of STIs. The burden of disease in Kenya has not been ascertained yet the numerous sequelae of these infections (P.I.D, infertility, abortions, prematurity, opthalmia neonatorum) are evident. To compound the problem, drug resistance patterns are rapidly changing. This study will ascertain both the disease burden/magnitude and the current drug resistance patterns in our setting and in so doing determine effective treatment modalities. Objective. To determine the prevalence of gonococcal and Chlamydia infection among women attending the reproductive health clinic (clinic 66) at Kenyatta National Hospital and also elucidate on the current drug sensitivity patterns in the sample population. Methodology. This was a cross-sectional study. The study was carried out between January 2015 and March 2015 in the reproductive health clinic (clinic 66) situated at the Kenyatta National Hospital. An interviewer administered questionnaire was used to gather socio-demographic data and to determine risk factors from all eligible women. Two endo-cervical swabs were collected from each participant and used to screen for N. gonorrhoeae using gram stain and culture technique and to conduct NAAT for C. Trachomatis. ix Results. 197 women attending the reproductive health clinic in KNH consented to participate in the study. The prevalence of N. gonorrhoeae was 8% while that of C. trachomatis was 2%. A majority of participants found to have C. trachomatis (50%) and N. gonorrhoeae (37%) were aged between 30-39 years. Majority of the participants found to have C. trachomatis were single (3/4, 75%) while those with N. gonorrhoeae were married (14/16, 87%). All participants who tested positive for C. trachomatis and N. gonorrhoeae were asymptomatic (100% for abdominal pain and 100% for per vaginal discharge). Resistance to routinely used antibiotics was noted and this is a cause of great concern. Conclusion. A significant proportion of women with Chlamydia trachomatis was identified among women attending the reproductive health clinic at Kenyatta National Hospital majority of whom were single. The prevalence of Neisseria gonorrhoeae was also found to be high. Majority of the patients were asymptomatic. The study reinforces the need to move away from syndromic approach for management of STIs and implement routine point of screening for STIs among FP clinic attendants and to increase preventive measures among. Regular antibiotic updates are required and a National programme on the rationale use of antibiotics is required. Recommendations. 1. There is need for point of care STI screening services to be introduced in FP clinics. 2. Antibiotic sensitivity monitoring for STIs should be instituted. 3. A National policy on the rational use of antibiotics for the management of STIs should be formulated.