Correlates of asymptomatic sexually transmitted infections among marginalized women in the Dominican Republic

Background: Sexually transmitted infections (STIs) continue to cause morbidity among women in resource-constrained settings, where asymptomatic infections are often overlooked due to syndromic management protocols. We investigated correlates of asymptomatic STIs among women in the Dominican Republic (DR). Methods: We analyzed data collected from cisgender women in DR between 2015 and 2019. Classified groups included pregnant youth (PY), people with HIV (PWH), residents of bateyes (RB), and sex workers (SW). Nucleic acid amplification or rapid plasma reagin tests detected STIs (Chlamydia/Gonorrhoeae/Syphilis/Trichomonas). Asymptomatic comprised no self-reported vaginal discharge, dysuria, groin lymphadenopathy, and genital/anal pain/ulcers. Logistic regressions identified sociodemographic, clinical, and behavioral correlates. Results: Among 833 asymptomatic women (median age 29, IQR 19-37), 35% were PY, 27% PWH, 11% RB, and 27% SW. STI prevalence was 24%: most (61%) had Chlamydia and few (≤25%) had Gonorrhoea, Syphilis, or Trichomonas. Asymptomatic STI correlates included age ≤24 (Adjusted Odds Ratio [aOR] = 2.32, [1.65-3.28]), early (≤14) sexual debut (aOR = 1.56, [1.11-2.18]), greater mobility (aOR = 1.41, [1.01-1.97]), lack of regular doctor (aOR = 1.42, [1.01-1.99]), and drug use in last 6 months (aOR = 1.88, [1.07-3.26]). Conclusions: Correlates of asymptomatic STIs—age, sexual debut, mobility, healthcare access, and drug use—should inform targeted screening and prevention efforts where diagnostic testing is not widely available.