International STD Research & Reviews

Clinical Epidemiological Assessment of Sexually Transmitted Infections among Reproductive-age Adults in Rivers State, Nigeria

Nduye Christie Tobin Briggs — 2026-06-13

Background: Sexually transmitted infections (STIs) cause substantial morbidity and adverse reproductive outcomes, yet population‑representative data from high‑burden settings like Rivers State, Nigeria, remain scarce. This study estimated the prevalence and correlates of curable and viral STIs among reproductive‑age adults using a clinical epidemiological approach.

Methods: A cross‑sectional analytic study enrolled 752 adults aged 15‑49 years from 15 health facilities and 10 community outreaches in Rivers State from February to October 2025. Structured interviews collected sociodemographic and behavioural data. Laboratory testing included nucleic acid amplification tests for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV); serological tests for active syphilis, HSV‑2, hepatitis B surface antigen (HBsAg), and HIV. Survey‑weighted logistic regression identified correlates of any curable STI.

Results: Weighted prevalence of any curable STI was 16.9% (95% CI 14.2–19.9): CT 8.1%, TV 6.2%, NG 2.9%, active syphilis 1.7%. HSV‑2 seropositivity was 40.2%, HBsAg 6.1%, and HIV 3.5%. Most curable infections (61.2%) were asymptomatic. Independent correlates of any curable STI included age 20‑24 years (AOR 1.51; 95% CI 1.00–2.30), ≥2 sexual partners in the past year (AOR 1.82; 1.30–2.55), inconsistent condom use (AOR 1.46; 1.02–2.10), and prior STI diagnosis (AOR 1.69; 1.10–2.58). Model discrimination was acceptable (AUROC 0.73).

Conclusion: Curable STIs affect one in six reproductive‑age adults in Rivers State, with most infections asymptomatic. Behavioural factors align with global risk patterns. Aetiological testing substantially improves case detection over syndromic management. Integration of targeted nucleic acid amplification testing, risk‑stratified screening, and strengthened partner services is urgently needed.

A Multilevel Beta Mixed-effects Analysis of the Non-linear Evolution of HIV Prevalence in Females Aged 15-24 Years

Francis Ayiah-Mensah — 2026-06-13

Background and Objectives: Despite significant strides being made in HIV prevention and treatment, adolescent girls and young women (AGYW) continue to be disproportionately affected by HIV infection globally. Many of the current studies on HIV prevalence globally have focused on linear or Gaussian-based models, which do not represent the bounded, skewed, nonlinear, and hierarchical nature of HIV prevalence data, and which may result in misleading inference and a lack of understanding of the dynamics of the HIV epidemic. The objective of this study was to describe long-term temporal trends and spatial variability in HIV prevalence among women aged 15-24 years at the population level with a sophisticated multilevel nonlinear modelling approach.

Method: A country-year panel dataset of 269 countries and territories in the World Development Indicators database (1990–2024) was analysed. HIV prevalence in the female population aged 15-24 years was the outcome variable. To model bounded prevalence proportions, multilevel beta mixed-effects regression was used, including natural cubic splines to model nonlinear temporal trends, random intercepts and slopes for country-specific heterogeneity, and repeated measurements. Model performance was evaluated by the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), likelihood ratio tests, and simulation-based residual diagnostics.

Results: The spline beta mixed-effects model with random intercepts and random slopes was the best model fit, with values of AIC = −60,918.34 and BIC = −60,858.28, respectively, significantly better than the linear model (ΔAIC = 3,657.51). Nonlinear temporal effects were highly significant (χ² = 3663.51, p < 0.001) and showed a sharp increase in the epidemics in the 1990s followed by a gradual decrease since 2000. Each spline component was significantly associated (p < 0.001) with HIV trajectories, which were complex, nonlinear, and significantly different. There was evidence of significant variation and clusters of high burden of disease across countries, especially in sub-Saharan Africa. The overall model performance was satisfactory according to the diagnostic assessments, and there was no sign of any problems regarding dispersion, influential outliers or zero-inflation.

Conclusion: This study proposes a comprehensive hierarchical beta spline modelling framework that overcomes several important challenges in the currently available literature on HIV prevalence studies by being able to model cross-country heterogeneity, longitudinal dependence, nonlinear epidemic evolution and bounded outcomes. This information echoes the longstanding disparities of HIV burden between men and women and within young women. To advance towards the end of the HIV epidemic and SDGs 3 and 5, targeted adolescent-focused HIV prevention programmes need to be strengthened, sexual and reproductive health services need to be made more accessible and gender-responsive interventions need to be implemented in high-burden settings.

Prevalence of Vaginal Candidiasis among Married Women in the Year 2021-2025 in Amachara General Hospital, Umuahia, Abia State, Nigeria

Elekeh, Rosemary Ichita — 2026-09-02

Background: Vaginal candidiasis is one of the most common fungal infections affecting women of reproductive age and remains an important public health concern due to its impact on reproductive health and quality of life. This study assessed the prevalence of vaginal candidiasis among married women attending Amachara General Hospital, Umuahia, Abia State, between 2021 and 2025.

Methods: A retrospective descriptive research design was adopted using hospital records of 327 married women diagnosed with vaginal candidiasis during the study period. The study described the demographic and clinical characteristics of the respondents, determined the proportions of laboratory-confirmed and clinically diagnosed cases, assessed the age-specific distribution of vaginal candidiasis, identified the predominant Candida species responsible for infection, and examined the association between parity and the occurrence of vaginal candidiasis. Data were analysed using descriptive statistics, while Pearson's correlation analysis was employed to examine the relationship between parity and the occurrence of vaginal candidiasis.

Results: The findings revealed that 38.5% of the respondents were unemployed, 37.0% were traders, and 24.5% were civil servants. The highest number of vaginal candidiasis cases was recorded in 2024 (25.4%), while the lowest occurred in 2023 (13.1%). Multiparous women constituted the largest parity category (39.8%). Most cases (86.9%) were laboratory-confirmed, whereas 13.1% were diagnosed clinically. Women aged 21–30 years recorded the highest proportion of cases (26.3%), while those aged 51 years and above accounted for the lowest proportion (12.2%). Candida albicans was identified as the predominant causative organism, accounting for 77.0% of infections, whereas non-albicans Candida species accounted for 4.0%. Pearson's correlation analysis demonstrated a weak positive but statistically non-significant relationship between parity and the occurrence of vaginal candidiasis (r = 0.0717, p = 0.1956).

Conclusion: Vaginal candidiasis remains a significant reproductive health concern among women of reproductive age attending Amachara General Hospital, with Candida albicans identified as the predominant causative organism. Strengthening routine laboratory diagnosis, promoting reproductive health education, encouraging early healthcare-seeking behaviour among women presenting with symptoms of vaginal candidiasis, and improving surveillance systems are recommended to reduce the burden of the disease. Further multicentre studies involving larger populations are recommended to investigate additional behavioural, clinical, and socioeconomic factors associated with vaginal candidiasis.

Clinical Outcomes and Treatment Adherence among Patients Receiving Care for Sexually Transmitted Infections in Primary Health Care Centres in Southern Nigeria

Nduye Christie Tobin Briggs — 2026-09-15

Background: Treatment adherence is critical for achieving favourable clinical outcomes in sexually transmitted infection (STI) care. Studies in Nigeria have consistently identified educational attainment, marital status, and the type of STI (particularly gonorrhoea) as predictors of adherence, with adherent patients demonstrating higher symptom resolution and lower recurrence. However, evidence directly linking adherence to these clinical endpoints within primary health care centre settings in Rivers State, Southern Nigeria, remains limited.

Objective: This study assessed treatment adherence and its association with clinical outcomes, namely symptom resolution, recurrence, and complications, among STI patients attending primary health care centres in two local government areas (LGAs) of Rivers State, Southern Nigeria.

Methods: A facility-based analytic cross-sectional study was conducted from April to July 2026 across six primary health care centres in two LGAs (Eleme and Oyigbo). Three PHCs were randomly selected from each LGA. A total of 634 adult STI patients were recruited using multistage sampling. Data were collected using structured questionnaires and medical record reviews. Adherence was assessed by self-report and pill count. Clinical outcomes were extracted from follow-up records. Bivariate and multivariable logistic regression analyses were performed, with statistical significance set at p < 0.05.

Results: The mean age was 29.4 ± 8.6 years; 47.0% were aged 20–29 years, and 58.2% (n = 369) were female. Overall treatment adherence was 52.1%. Adherence was higher among females (56.7% vs 46.2%), married participants (61.3% vs 47.8%), and tertiary-educated participants (62.4% vs 39.5%). Chi-square tests showed significant associations between adherence and education level (p<0.001), marital status (p=0.002), and sex (p=0.009). Multivariable analysis identified tertiary education (AOR=2.1, 95% CI: 1.4–3.2) and married status (AOR=1.8, 95% CI: 1.2–2.7) as positive predictors, while gonorrhoea diagnosis (AOR=0.7, 95% CI: 0.5–0.9) was a negative predictor. Among adherent patients, 81.6% achieved complete symptom resolution compared to 42.9% of non-adherent patients; recurrence was 9.3% among adherent patients versus 28.7% among non-adherent patients.

Conclusion: In this population, treatment adherence was suboptimal and was independently associated with education, marital status, and gonorrhoea diagnosis. Adherent patients experienced substantially higher symptom resolution and lower recurrence. Interventions targeting less-educated, single, and gonorrhoea-diagnosed patients are needed.

Severity and Associated Factors of Depression among People Living with HIV/AIDS in the Bamenda Municipality, Cameroon

Victor Gutoh Nkwanui — 2026-09-30

Background: Depression is an important mental health comorbidity among people living with HIV/AIDS (PLWHA), yet evidence describing its severity, diagnostic subtypes, symptom patterns, and associated factors in Bamenda Municipality remains limited.

Aims: To assess the prevalence, severity, depressive disorder subtypes, commonly reported symptoms, and associated factors of depression among adults living with HIV/AIDS in Bamenda Municipality, Cameroon.

Study Design: Facility-based cross-sectional study.

Place and Duration of Study: Four HIV treatment centres in Bamenda Municipality, Cameroon, over a period of two years.

Methodology: A total of 1,068 adults living with HIV/AIDS were recruited using a three-stage sampling procedure. Four HIV treatment centres were purposively selected based on patient volume and service capacity. The sample size was proportionally allocated across facilities, and eligible adults were consecutively recruited until the required sample size was attained. Depression was assessed using the Hamilton Depression Rating Scale (HAM-D) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Data were analysed using descriptive and multivariable logistic regression analyses. Statistical significance was set at p < 0.05.

Results: The prevalence of depression was 37.8% (404/1,068). Mild depression was the most common severity category (57.7%, n = 233), followed by moderate depression (17.1%, n = 69). Among the 404 depressed participants, Major Depressive Disorder accounted for 37.1% (n = 150), Unspecified Depressive Disorder for 35.4% (n = 143), and Persistent Depressive Disorder for 27.5% (n = 111). Significant factors associated with depression included male gender (AOR = 2.224, 95% CI: 1.512-3.270, p = 0.001), being divorced (AOR = 7.722, 95% CI: 2.001-14.890, p = 0.006), longer duration of HIV infection (AOR = 1.145, 95% CI: 1.021-1.285, p < 0.05), lower educational attainment (AOR = 1.876, 95% CI: 1.210-2.905, p < 0.05), higher HIV-related stigma (AOR = 1.320, 95% CI: 1.180-1.480, p < 0.001), lower social support (AOR = 0.812, 95% CI: 0.701-0.940, p < 0.001), and self-harm behaviour (AOR = 2.218, 95% CI: 1.889-2.606, p < 0.001).

Conclusion: Depression was common among people living with HIV/AIDS in Bamenda Municipality. Mild depression predominated, while Major Depressive Disorder was the most frequent diagnostic subtype. Routine depression screening, stigma reduction strategies, and strengthened psychosocial support should be integrated into HIV care services.