Experts warn untreated STIs fueling infertility, HIV in Kenya

Experts are sounding the alarm over the rising prevalence of untreated sexually transmitted infections (STIs) in Kenya, warning that they are silently driving infertility rates and fuelling new HIV infections.

At least half of those who test positive for STIs show no symptoms, a situation health officials say calls for urgent investment in routine screening and targeted treatment.

The revelations came during the unveiling of the AHF Kenya STI Super Clinic in Mathare, Nairobi, now the country’s largest stand-alone comprehensive care centre dedicated to sexual and reproductive health.

The facility is equipped with cutting-edge polymerase chain reaction (PCR) machines capable of testing for 12 infections at a go, enabling clinicians to confirm the exact cause of infections such as syphilis, gonorrhoea and chlamydia before treatment is initiated.

“At Mathare we are launching a new service we’re calling wellness. We screen for all types of STIs and treat based on laboratory evidence, not guesswork,” said Dr Samuel Kinyanjui, Country Director, AIDS Healthcare Foundation (AHF) Kenya.

AHF is collaborating with Kenya Medical Research Institute (Kemri) to conduct more research on treatment of STIs.

Kinyanjui said two to five per cent of patients undergoing syndromic treatment for STIs fail to recovery.

This is despite undertaking first, second and third line of treatment.

“By introducing PCR testing and collaborating with KEMRI on culture and drug-sensitivity testing, we can precisely identify the cause and select the drug that works. That means faster recovery for clients and fewer chances of onward transmission.”

Clinicians describe STIs as a “silent epidemic,” pointing to the large number of clients who carry infections unknowingly.

According to AHF Kenya, at least 20 people visit the clinic daily, with a positivity rate of roughly 75 per cent for the three leading STIs, namely syphilis, gonorrhoea and chlamydia.

“Many of our clients are adolescents and young people, and interestingly, about half of them come without symptoms but test positive for STIs,” said Joshua Shumbuya, a clinical officer at AHF Kenya.

“Routine screening is critical to catch these infections early and prevent long-term complications like infertility.”

Left untreated, STIs can lead to blocked fallopian tubes, chronic pelvic pain and ectopic pregnancies in women, as well as reduced sperm count and quality in men.

They also increase vulnerability to HIV infection because lesions and inflammation create entry points for the virus.

Kenya’s public health system has traditionally relied on syndromic management, a method of treating patients based only on visible symptoms.

While useful in resource-limited settings, experts warn that this approach often leads to under-diagnosis, overtreatment, and missed infections, especially in asymptomatic cases.

“PCR is the gold standard but often out of reach due to cost. AHF’s investment bridges that gap,” said Dr Stephen Ndolo, Director of Promotion and Programme Management at the National Syndemic Diseases Control Council (NSDCC).

He said diagnosing specific infection, rather than treating syndromes alone, improves outcomes and protects the wider community from infection.

A single PCR test costs between Sh4,800 and Sh5,500, but the entire cost including consultation, medication and follow-up is absorbed by AHF Kenya with support from partners.

The average value of a “wellness” episode of care is estimated at Sh7,500, provided at no charge to the client.

The Mathare Wellness Clinic is designed as a one-stop hub for sexual and reproductive health services including STI counselling, testing and health education.

Other services to be offered include PCR-based STI diagnosis and treatment for gonorrhoea, chlamydia, syphilis and HIV, HIV prevention services including Pre-Exposure Prophylaxis (PrEP) Post-Exposure Prophylaxis (PEP), and condom education and distribution, partner notification and follow-up to prevent reinfection and TB screening and treatment.

Maternal, child and adolescent services, including prevention of mother-to-child transmission of HIV, immunisation and HPV vaccination, shall also be offered at the center.

Individuals visiting the center are registered using unique identifiers to protect privacy.

After counselling and risk assessment, clinicians order urine, blood or swab tests.

Those with recurrent or resistant infections are referred for culture and drug-sensitivity testing through AHF’s partnership with Kemri.

Anthony Kiplagat, Head of the HIV, STI and Viral Hepatitis Programme at the Nairobi County Government, said the facility will help fill critical data gaps that have hindered effective STI control.

“For a long time, STIs have been a silent epidemic. With this partnership, we can finally collect data specific to STIs and improve the quality of care,” said Kiplagat. 

Mathare is being used as a sentinel surveillance site to inform national STI treatment guidelines.

Data collected here will guide drug procurement, monitor resistance patterns, and shape prevention campaigns targeting high-risk groups such as adolescents, sex workers and key populations.

While most clients prefer to remain anonymous, clinicians say many patients come to the clinic after experiencing repeated infections or failed treatment elsewhere.

“One young woman told us she had been treated three times for gonorrhoea, but the infection kept coming back. When we did PCR testing, we discovered the strain was resistant to the drug she was given. We switched to the right antibiotic, and she finally got better,” said Shumbuya.

He said such cases highlight the value of evidence-based treatment and the danger of self-medication or incomplete treatment, which contribute to rising antimicrobial resistance.

Experts noted that the Mathare clinic will bridge long-standing gaps in financing and service delivery, ensuring Nairobi residents, including vulnerable groups such as adolescents and street families, can access timely, high-quality care.

AHF Kenya is set to sign a memorandum of understanding with KEMRI before World AIDS Day in December to strengthen drug resistance surveillance.

An online booking portal is also being developed to reduce patient waiting times.