High burden of sexually transmitted infections and low treatment uptake among adolescent girls and young women in Ugandan fishing communities: a cross-sectional study

Adolescent girls and young women (AGYW) in sub-Saharan Africa bear a disproportionate burden of sexually transmitted infections (STIs), which increase biological susceptibility to HIV. Fishing communities along Lake Victoria in Uganda are high-risk settings but remain underserved in sexual and reproductive health (SRH) services. We estimated STI prevalence and evaluated factors associated with STI and treatment-seeking behavior among AGYW in these communities to inform targeted HIV prevention strategies. We conducted a cross-sectional analysis of 400 AGYW aged 15-24 years enrolled in a prospective cohort in fishing communities along Lake Victoria, Uganda, from August 2023 to January 2025. Participants underwent clinical assessment, and vaginal swabs and blood samples were collected and tested for multiple STIs, including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Treponema pallidum , herpes simplex virus-2 (HSV-2), and human papillomavirus (HPV). Data on socio-demographics, sexual behavior, and healthcare utilization were collected through structured interviews. Multivariable logistic regression was used to identify factors associated with STI and treatment-seeking behavior. Among 400 AGYW, the mean age was 19.5 years (SD 2.9), and 294 (73.5%) had at least one laboratory-confirmed STI. HSV-2 was the most prevalent infection (44.8%, 179/400), followed by HPV (39.3%, 157/400), CT (16.0%, 64/400), TV (9.5%, 38/400), NG (1.8%, 7/399), and syphilis (0.8%, 3/365). Among 172 participants reporting STI-related symptoms, only 56 (32.6%) had sought formal healthcare before study enrolment. In multivariable analysis, age 18-24 years (aOR 1.78, 95% CI 1.11-2.86), transactional sex (aOR 1.89, 95% CI 1.18-3.03), and parenthood (aOR 2.00, 95% CI 1.24-3.22) were independently associated with having at least one STI. Among symptomatic participants, secondary education or higher (aOR 2.48, 95% CI 1.21-5.09), genital discharge (aOR 2.73, 95% CI 1.27-5.88), and genital odor (aOR 2.58, 95% CI 1.14-5.88) were independently associated with healthcare-seeking. AGYW in fishing communities experience a high burden of STIs, particularly viral infections alongside low treatment uptake for symptomatic individuals. These findings highlight the need for integrated, youth-friendly STI screening, treatment, and prevention strategies including HPV vaccination within HIV programs to reduce STI and HIV transmission and improve SRH outcomes in high-risk settings.