Determinants of the Occurrence of Self-Reported Sexually Transmitted Infections (STIS) among Adolescent Girls in the City of Goma: An Analytical Cross-Sectional Study from January to April 2025 ()
1. Introduction
Sexually transmitted infection (STI) is any infection transmitted through blood, semen, vaginal fluids or other bodily fluids while sexually transmitted disease (STD) refers to a disease that develops from an STI [1]-[3].
STIs are caused by more than 30 different bacteria, viruses and parasites transmitted during vaginal, anal or oral sex with an infected partner or from mother to child, during pregnancy, during childbirth and during breastfeeding [2].
Of the eight common infections, four can be cured, namely syphilis, gonorrhea, chlamydia and trichomoniasis. On the other hand, viral infections including hepatitis B, herpes simplex virus (HSV), HIV and human papillomavirus (HPV) are not curable [3].
Adolescents and young adults are the most affected by STIs, probably due to behavioral, cognitive and biological factors linked to this age. The most common STIs are of bacterial origin and therefore curable [4] [5].
STIs have a direct impact on sexual and reproductive health through stigma, infertility, cancers and pregnancy complications, and they can increase the risk of contracting the human immunodeficiency virus (HIV) [3]. Their spread is mainly due to their varied clinical presentation, which includes urogenital, pharyngeal and rectal involvement as well as a large number of asymptomatic cases [6]. The prevalence of sexually transmitted diseases remains high worldwide, despite diagnostic and therapeutic improvements in these infectious diseases that rapidly eliminate the contagiousness of patients [7] [8].
According to the World Health Organization (WHO), more than one million people contract a curable STI every day. In 2020, an estimated 374 million people contracted one of four STIs: chlamydia (129 million), gonorrhea (82 million), syphilis (7.1 million), and trichomoniasis (156 million) [3].
In sub-Saharan Africa, estimates show that the prevalence of STIs is higher among girls aged 15 - 24 years than among women aged 25 - 49 years [9].
In Nigeria, Human papilloma virus was found in 13.2% of vaginal swabs from girls with a mean age of 14.9 (2.3) years [10].
Using detailed longitudinal observation, a study conducted in Kenya found that Kenyan adolescent girls had almost no bacterial vaginosis before first sexual intercourse and that the onset of sexual activity was the most important risk factor for both prevalent and incident bacterial vaginosis [11].
In Mali, the prevalence of STIs among adolescent girls and young women was estimated by one study to be 14.1% (95% CI = 12.3 to 16.2). Adolescent girls and young women who had already been tested for HIV, those with multiple sexual partners and those residing in urban areas were more likely to self-report STIs [12].
The third Demographic and Health Survey carried out in the Democratic Republic of Congo noted an estimated HIV prevalence of 0.8% among adolescents aged 15 - 19 years [13].
The prevalence of sexually transmitted infections (STIs) in Goma, Democratic Republic of Congo, is of concern, particularly among adolescents. A 2007 report by Radio Okapi indicated an HIV/AIDS prevalence rate of 7% among adolescents, while the national average was approximately 4%. Furthermore, 2021 data from the National Multi-sectoral AIDS Control Program (PNMLS) reveal that women are more affected by HIV than men, with 58,524 women and 34,386 men living with HIV [14]. This is what prompted us to conduct this study in this city where adolescent girls are more exposed to rape by minors.
The objective of this study was to determine the determinants of STIs among adolescent girls in the city of Goma.
2. Materials and Methods
Type and period of study: this is an analytical cross-sectional study which covers the period from January 5, 2024 to April 5, 2025, i.e., 1 year and 3 months in the city of Goma.
2.1. Study Population
Adolescent girls from the city of Goma constituted the population of this study.
2.2. Inclusion Criteria
All adolescent girls living in the city of Goma at the time of the study were included in the study.
2.3. Exclusion Criteria
Excluded from the study were adolescent girls who had been living in the city of Goma for less than three months at the time of the study and whose parents’ or guardians’ permission to participate in the study had not been obtained.
2.4. Sample Size Calculation and Sampling Techniques
The sample size was calculated using the following formula:
,
With n: the sample size, p: proportion of adolescent girls who have already contracted a sexually transmitted infection, i.e. 14.1% [12], q: proportion of adolescent girls who have never contracted a sexually transmitted infection, i.e.: 1 − p = 1 − 0.141 = 0.859, α: risk of precision = 0.05, Zα = deviation corresponding to a confidence level of 95%. The minimum sample size was 186 adolescent girls. By adding 20% of expected non-respondents, the sample size was increased to 213 adolescent girls.
2.5. Sampling Method
The adolescent girls who participated in the study were randomly selected at several stages in the health zones (HZ) of Goma and Karisimbi. The sample was distributed proportionally to the populations of these two health zones. Thus, five neighborhoods were randomly selected in the Karisimbi HZ based on the list of neighborhoods in this health zone. In each neighborhood, eight avenues/streets were also randomly selected and on each avenue/street six households were randomly selected. The first plot to be selected was the first on the right from the north entrance of the avenue/street.
If a plot contained more than one household, only one was selected using the following procedure: the households were numbered, then one household was drawn using the random number generator in the Open Epi software. If there was more than one adolescent girl in the selected household, only one was drawn using the same procedure as the household.
In the Goma health zone, five neighborhoods were randomly selected from the complete list of neighborhoods. Within each neighborhood, five avenues/streets were randomly selected, and six households were selected from each avenue/street. Households and respondents were selected in the same manner as those in the Karisimbi health zone. Using this procedure, 137 adolescent girls were selected from the Karisimbi health zone and 76 from the Goma health zone.
2.6. Data Collection
A structured, pre-tested questionnaire, deployed on Kobocollect, was administered face-to-face to adolescent girls. This questionnaire included identification questions, prevalence-related questions, and questions related to determinants. The dependent variable of this study was whether or not they had ever suffered from STIs. This research was evaluated over a twelve-month period.
The following independent variables were collected: socio-demographic characteristics, gyneco-obstetric characteristics, health characteristics,
2.7. Data Processing and Analysis
Data were analyzed using Epi info 7.2. Qualitative variables were summarized as absolute and relative frequencies, while age was summarized as median and range. Crude odds ratios (ORb) were calculated to examine associations between the dependent variables one after the other with the independent variables. All variables that showed a statistically significant association with a p-value less than 5% in the bivariate analysis were entered into a binary logistic regression model. Adjusted odds ratios were calculated to examine the determinants of STI occurrence. Any association was considered statistically significant when the p-value was less than 5%. Odds ratios were calculated with 95% confidence intervals.
2.8. Ethical Considerations
Informed consent was obtained from the parents or legal guardians of the selected adolescents, and assent was also obtained from the selected adolescents before administering the questionnaire. Parents or legal guardians were permitted to attend the interview at their request or that of the adolescents. Participation in the survey was voluntary and anonymous.
2.9. Bias
Memory bias was controlled by looking at information from the past three months.
3. Results
Of the 388 adolescent girls surveyed in the city of Goma to research the determinants of sexually transmitted infections, 190 or 48.97 (95% CI: 44.03% - 53.93%) reported having presented symptoms suggestive of a sexually transmitted infection over the past 12 months (See Table 1).
Table 1. Distribution of respondents according to socio-demographic characteristics.
Variables |
Number |
% |
Age groups [Median age: 16 years, range: 10 – 19 years] |
10 - 12 years old |
56 |
14.43 |
13 - 15 years old |
111 |
28.61 |
16 - 19 years old |
221 |
56.96 |
Residence |
ZS Goma |
196 |
50.52 |
ZS Karisimbi |
192 |
49.48 |
Religion |
Adventist |
54 |
13.92 |
Christian |
235 |
60.57 |
Muslim |
71 |
18.30 |
Without religion |
28 |
7.22 |
Education level |
None |
48 |
12.37 |
Primary |
97 |
25.00 |
Secondary |
214 |
55.15 |
Superior |
29 |
7.47 |
Family type |
|
|
Two-parent |
160 |
41.24 |
Single parent |
228 |
58.76 |
Social level |
Down |
57 |
14.69 |
AVERAGE |
94 |
24.23 |
Pupil |
237 |
61.08 |
Lives with his parents |
No |
114 |
29.38 |
Yes |
274 |
70.62 |
Family situation |
Orphan |
65 |
16.75 |
Married parents |
242 |
62.37 |
Separated/divorced parents |
81 |
20.88 |
Lives in an environment with common early sexual behaviors |
No |
52 |
13.40 |
Yes |
336 |
86.60 |
Table 2 shows that adolescent girls aged 13 to 15 were the most represented with 111 (28.61%). The median age of the respondents was 16 years with extremes of 10 - 19 years. Secondary education level was reached by 214 (55.15%), the majority were from single-parent families 228 (58.76%) and 336 (86.6%) of them lived in an environment with common early sexual behaviors.
Analysis of Table 3 showed that 221 (56.96%) had already experienced sexual intercourse and the majority, 107 (57.53%), had their first sexual intercourse between the ages of 15 and 17. It should be noted that for 172 (91.2%), the first
Table 2. Distribution of respondents according to their sexual behavior and STI clinic.
Variables |
Number |
% |
Already has sexual intercourse |
No |
167 |
43.04 |
Yes |
221 |
56.96 |
Age at first sexual intercourse |
<15 years old |
49 |
26.34 |
15 - 17 years old |
107 |
57.53 |
18 - 19 years old |
30 |
16.13 |
Older partner at first sexual intercourse |
No |
17 |
8.99 |
Yes |
172 |
91.01 |
Number of partners during his life |
1 |
129 |
70 |
2 - 3 |
51 |
28 |
>3 |
5 |
2 |
Last sexual intercourse |
<1 week |
50 |
26.46 |
1 - 2 weeks |
45 |
23.81 |
>2 weeks |
94 |
49.74 |
Already used condom during sexual intercourse |
No |
251 |
64.69 |
Yes |
137 |
35.31 |
Condom supply location |
|
|
Free distribution |
35 |
15.84 |
Pharmacy |
177 |
80.09 |
Supermarket |
9 |
4.07 |
Knowledge of the risks of multiple sexual partners |
No |
99 |
25.52 |
Yes |
289 |
74.48 |
Motivation for first sexual intercourse |
Financial needs |
37 |
19.58 |
Personal curiosity |
59 |
31.22 |
Peer pressure |
27 |
14.29 |
Romantic relationship |
66 |
34.92 |
STI symptoms presented |
Abnormal vaginal discharge |
143 |
75 |
Genital ulcers |
19 |
10 |
Venereal vegetations (condylomas) |
7 |
4 |
Lower back pain |
21 |
11 |
sexual partner was older, most, 129 (70%), had only had one sexual partner in their lifetime and 94 (49.74%) had their last sexual intercourse more than two weeks ago. The risk of having multiple sexual partners was known to 289 (74.48%) adolescent girls and romantic relationships were the main reason for first sexual intercourse, 59 (31.22%). discharge was the most commonly reported syndromic type of STI by 143 (75%).
Respondents cited unwanted pregnancies (96.19%) as the main risk of multiple sexual partners, the second risk cited was followed by contracting STIs (92.04) (Figure 1).
In Figure 2 below, school was the main channel through which adolescent girls heard the most about STIs (80.63%) followed by parents (63.03%).
The results of the bivariate analysis presented in Table 3 show that the risk of contracting STIs increased with age and that adolescent girls in primary school were less at risk of contracting STIs (OR: 0.08; 95% CI: 0.03 - 0.2; p = 0.000). On the other hand, lack of awareness of the risks incurred with multiple sexual
Figure 1. Risks of multiple sexual partners cited by respondents.
Figure 2. Sources of information on sexually transmitted infections.
Table 3. Factors associated with the occurrence of sexually transmitted infections among adolescent girls in the city of Goma.
Variables |
IST |
Odds ratio |
95% CI |
p |
Yes n (%) |
No n (%) |
Age groups |
10 - 12 years old |
1(0.53) |
55 (27.78) |
1 |
|
|
|
13 - 15 years old |
26 (13.68) |
85 (42.93) |
16.65 |
2.992 |
354.5 |
0.000 |
16 - 19 years old |
163 (85.79) |
58 (29.29) |
153.9 |
29.01 |
3198 |
<0.000 |
Residence |
ZS Karisimbi |
96 (50.53) |
96 (48.48) |
1.08 |
0.72 |
1.61 |
0.687 |
ZS Goma |
94 (49.47) |
102 (51.52) |
1 |
|
|
|
Education level |
None |
29 (15.26) |
19 (9.6) |
0.58 |
0.20 |
1.58 |
0.299 |
Primary |
18 (9.47) |
79 (39.9) |
0.08 |
0.03 |
0.22 |
0.000 |
Secondary |
122 (64.21) |
92 (46.46) |
0.50 |
0.20 |
1.17 |
0.116 |
Superior |
21 (11.05) |
8 (4.04) |
1 |
|
|
|
Family type |
Single parent |
116 (61.05) |
112 (56.57) |
1.20 |
0.80 |
1.80 |
0.369 |
Two-parent |
74 (38.95) |
86 (43.43) |
1 |
|
|
|
Social level |
Down |
28 (14.74) |
29 (14.65) |
1.09 |
0.61 |
1.96 |
0.757 |
AVERAGE |
51 (26.84) |
43 (21.72) |
1.34 |
0.83 |
2.18 |
0.226 |
Pupil |
111 (58.42) |
126 (63.64 |
1 |
|
|
|
Knowledge of the risks of multiple sexual partners |
No |
151 (79.5) |
138 (69.7) |
1.68 |
1.05 |
2.67 |
0.027 |
Yes |
39 (20.5) |
60 (30.3) |
1 |
|
|
|
Already used condom during sexual intercourse |
No |
151 (70) |
138 (2.02) |
113.1 |
40.09 |
319.4 |
0.000 |
Yes |
39 (30) |
60 (97.98) |
|
|
|
|
Lives with his biological parents |
No |
68 (35.8) |
46 (23.2) |
1.8 |
1.18 |
2.87 |
0.006 |
Yes |
122 (64.8) |
152 (76.8) |
|
|
|
|
partners (OR: 1.6; 95% CI: 1.05 - 2.67; p = 0.027), never having used a condom during sexual intercourse (OR: 113.1; 95% CI: 40.09 - 319.4; p = 0.000), not living with biological parents (OR: 1.8; 95% CI: 1.18 -2.87; p = 0.006) were associated with the occurrence of STIs.
Multivariate analysis identified the age group of 16 to 19 years (ORa: 48.39; 95% CI: 5.72 - 408.85; p = 0.0004) as risk factors for the occurrence of STIs and having ever used condoms during sexual intercourse (ORa: 0.014; 95% CI: 0.004 - 0.041; p = 0.0000) reduced the risk of contracting STIs (See Table 4).
Table 4. Determinants of the occurrence of sexually transmitted infections among adolescent girls.
Variables |
ORa |
95% CI |
P-value |
Age groups (13-15 years/10-12 years) |
6.95 |
0.82 |
58.77 |
0.0748 |
Age groups (16 - 19 years / 10 - 12 years) |
48.39 |
5.72 |
408.85 |
0.0004 |
Education Level (Primary/None) |
0.80 |
0.23 |
2.77 |
0.7327 |
Education Level (Secondary/None) |
0.76 |
0.27 |
2.15 |
0.6118 |
Education Level (Higher/None) |
0.45 |
0.09 |
2.07 |
0.3078 |
Knowledge of the risks of multiple sexual partners (Yes/No) |
1.33 |
0.65 |
2.72 |
0.4291 |
Lives with parents (Yes/No) |
0.61 |
0.30 |
1.23 |
0.1716 |
Have ever used condoms during sexual intercourse (Yes/No) |
0.014 |
0.004 |
0.041 |
0.0000 |
4. Discussion
In our series, the prevalence of STIs was 48.97% while the study of Tae Hoon Oh et al. found a prevalence of 17.4%. This difference could be due to the fact that our study was conducted in the community while that of Tae Hoon Oh et al. [14] was conducted in a medical training limiting the possibility of including people suffering from STIs.
The majority of our respondents lived in an environment where early sexual behaviors were common. This is explained by the fact that social media and television content to which adolescent girls are exposed place them in an environment where early sexual behaviors are very common and no longer taboo.
Most of the adolescents had already had sexual intercourse and were between 15 and 17 years old at the time of the incident. These results are similar to those of Marie N. Esther Destil [15].
This could be explained by the fact that Haiti, where she conducted her study, and the Democratic Republic of Congo, where we conducted ours, are both resource-limited countries.
The main source of information about STIs was the school. Indeed, current school curricula emphasize courses that cover topics related to sexuality and related subjects.
Our study shows that the risk of contracting sexually transmitted infections increased with age. This result is similar to that of C Duval [16]. We believe that the older the adolescent girls, the more they engage in sexual experiences, sometimes without protection, thus exposing them to STIs.
Non-use of condoms has emerged as a risk factor for STIs. A study conducted among adolescent girls in Bouake reached similar conclusions. Indeed, it is scientifically proven that the correct use of condoms protects against STIs [17].
Lack of knowledge about the risks of STIs incurred during sexual intercourse with multiple sexual partners has been identified as a risk factor. Grondin found similar results [18]. Practicing sexual relations with multiple partners does indeed expose people to the risk of contracting STIs.
Not living with biological parents was a risk factor for STI risk. It appears that children not living with their biological parents benefit less from supervision in a family setting that can provide them with a good education. Grondin showed in his study that the absence of dialogue with parents on subjects related to sexuality encourages risky sexual practices among adolescent girls [18].
5. Conclusions
The prevalence of sexually transmitted infections among adolescent girls in the city of Goma is high. The majority were sexually active and had only one sexual partner. The age of first sexual intercourse ranged from 15 to 17 years. Romantic relationships were the main reason for first sexual intercourse. In addition, abnormal vaginal discharge was the most commonly reported syndromic type of STI among respondents. Age was identified as a risk factor for contracting STIs, while having previously used condoms during sexual intercourse protected against STIs.
Raising awareness among adolescent girls about STIs will reduce the risk of contracting them and improve their sexual health.
Conflicts of Interest
The authors declare no conflicts of interest.