Lower Genital Tract Infections in women in Kenya: Studies to improve management and insight into vulvovaginal candida infections

The consequences of missed or mismanaged LGTI and RVVC are wide and dire for individual patients, their families, communities and governments; they include psychosocial and clinical complications, economic loss and wastages, and development of resistance to anti- microbials. My thesis work exposes the weightiness of the LGTI and RVVC problems and the challenges in management among women in Kenya, reveals preliminary RVVC-linked genomic and proteomics data unique to the local population, and showcases aspects of mucosal work relevant for LGTI and RVVC diagnostics and research. I detected concerning gaps in patient care. While syndromic treatment has been considered to be the befitting approach in LGTI management for Kenya and other resource-constrained environments, the approach has weaknesses and shortfalls including poor implementation, misuse of antimicrobials, and failures in treatment especially for patients with mixed or recurrent infections including RVVC. As crucial foundational pioneer ventures in an African population, I revealed distinct RVVC related genetic variations and the systemic proteome signature connected to RVVC.
To improve patient outcomes in Kenya and similar environments, LGTI and RVVC management should be targeted and wholistic, with an interlinked approach advised by accurate diagnostics, including mitigating measures for any associated unfavourable psychosocial effects. This calls for further research to understand the enablers and barriers that impact accurate implementation of the syndromic treatment guidelines, design better performing treatment guidelines, develop feasible POC tests with easy and favourable implementation modes, and research towards a better understanding of the pathophysiology for targeted biomarkers and therapeutics for RVVC. There is thus a need for novel complementary and synergistic multidimensional approaches to the management of LGTI and RVVC, which calls for continued investment in healthcare infrastructure, training, oversight, timely corrective actions, and research.