# Incident STIs in Kenyan Girls: a prospective cohort spanning sexual debut

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2020 · $323,278

## Abstract

Project Summary
Adolescent girls in sub-Saharan Africa are disproportionately affected by sexually transmitted infections (STIs)
and HIV. Sexually active African adolescents are known to have high levels of vaginal inflammation. We
hypothesize that even pre-sexual debut, African adolescent girls may have elevated vaginal inflammation and
elevated vaginal microbial diversity, which will influence their genital immunological maturation, microbiome,
and later susceptibility to STIs. We further hypothesize that sexual debut may result in persistent genital
inflammation and increased bacterial diversity. We will extend a pre-existing 3 year cohort of adolescent girls in
Thika, Kenya, recruited between ages 16-18 and pre-sexual debut, and follow them 2 additional years, for a
total of 5 years, and determine incident gonorrhea, chlamydia, and trichomonas infection. Our first aim is to
conduct a case-control study comparing the inflammatory profiles in cervicovaginal lavage (measured by
cytokines IL-6, IP-10, IL-1a and MIP-1b and others) of girls who acquire STIs with controls. We will also
compare baseline density of inflammatory cells of vulvar biopsy specimens between cases and controls, and
we will compare broad-range PCR measurements of vaginal microbial diversity, and quantification by PCR of
specific high-risk anaerobes between girls who acquire STIs and controls. Our second aim is to analyze pre-
and post-sexual debut changes in inflammation, microbial diversity, and cell density. We also will analyze the
role of progestin-based contraceptives and lifetime estrogen exposure (time from menarche to sexual debut) to
evaluate the effects of hormonal variation on STI risk factors. We will collaborate with expert immunologists to
perform rigorous MSD analysis of vaginal inflammatory markers, use cutting edge histopathological methods to
evaluate tissue inflammation, and propose innovative full-length amplicon microbiome measurement
techniques to overcome imprecision in urogenital species identification. Our approach is efficient as it
leverages and extends an existing adolescent cohort with high retention rates, and is unique as we have
successfully collected pre-sexual debut cervicovaginal lavage, microbiota and vulvar biopsy specimens from
adolescent girls. Our results will provide a comprehensive picture of pre-sexual debut immunology of African
adolescent girls, identify factors that promote STI acquisition, and will further demonstrate evolution of girls'
genital tract immunity and microbiome as they begin having sex. We expect that this approach will identify
modifiable biological risk factors to reduce STI acquisition among adolescent girls, and results can be used to
develop STI prevention methods and multi-purpose technologies.

## Key facts

- **NIH application ID:** 10001556
- **Project number:** 5R01HD091996-04
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Alison Christina Roxby
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $323,278
- **Award type:** 5
- **Project period:** 2017-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10001556

## Citation

> US National Institutes of Health, RePORTER application 10001556, Incident STIs in Kenyan Girls: a prospective cohort spanning sexual debut (5R01HD091996-04). Retrieved via AI Analytics 2026-05-31 from https://api.ai-analytics.org/grant/nih/10001556. Licensed CC0.

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