Discussion
Herpes Simplex, infections, 2016–2021
STIS, HERPES SIMPLEX, INFECTIONS, BACTERIAL VAGINOSIS
We found approximately 10% of women in Lower River Region of The Gambia testing positive for at least one STI, with the highest prevalence being for The proportion of women testing positive for an STI was comparable to findings from other STI prevalence studies from the region. A meta-analysis of data from several countries estimated the WHO Africa region (AFRO) prevalence of Despite the variation in sampling and testing methods used in other studies, the similarity between these findings and previous studies was notable. At almost 8%, our data suggest WHO identified strengthening STI surveillance and improving knowledge of prevalence (alongside symptom aetiology and antimicrobial resistance) as priorities in their STI strategy for 2016–2021 [The study has two key strengths. First, data in this study were collected from a sample of the general population in sub-Saharan Africa. General population samples are more generalizable to the wider population than some other common STI survey sampling methods, such as sampling of clinic attendees or high-risk groups. No published evidence of STI prevalence in this population were available at the time of the study, and very few data on STIs were available from The Gambia as a whole. Also, low- and middle-income countries in sub-Saharan Africa are under-represented in global estimates of STI burden. Second, recommended diagnostic approaches were used to detect STIs in this study: nucleic acid amplification tests for diagnosis of There were also limitations to this study. First, for detection of Several unanswered questions remain. First, larger, randomly sampled surveys and longitudinal prevalence monitoring are needed to expand the map of STI prevalence in The Gambia. Compared to the general population, high-risk populations such as female sex workers often bear a disproportionately high proportion of STIs. Inclusion of these groups in future surveillance efforts is important. Men should also be included. Second, several key infections of the reproductive tract (for example, HIV, Herpes Simplex Virus, bacterial vaginosis, Our data, combined with those from elsewhere, will contribute to baseline STI prevalence estimates in The Gambia, laying a foundation for more systematic monitoring of the key challenges facing STI prevention, such as characterisation of antimicrobial susceptibility profiles among pathogen isolates and determining whether prevalence is changing over time. There is growing concern about STIs at the global level; the increasing evidence base in The Gambia should provide leverage for policy makers to ensure STIs are appropriately prioritised.