The term “sexually transmitted infections” (STIs) refers to a pathogen that causes infection through sexual contact (1). Naturally, STIs affect individuals within partnerships and larger sexual networks, and in turn, the general population (2, 3). STIs are a global public health issue, especially in developing countries (4), contributing significantly to morbidity (the rate of disease) and mortality (the rate of death) in the population (5). The World Health Organization (WHO) reported 374 million new cases of curable STIs annually in 2021 (6), with sub-Saharan Africa accounting for 40% of the global burden (7). Currently, over a million STIs are acquired daily, with approximately half a billion new cases of STIs reported annually worldwide (8, 9). In Côte d’Ivoire, epidemiological studies have revealed that over 10% of women have STIs (10). In addition, a cross-sectional study of women in Côte d’Ivoire found that 5.5% had chlamydial infections and 3.7% had gonococcal infections (11).

The greater impact of STIs on women compared with men is partly due to the female anatomy. The female urogenital system is more exposed and vulnerable to STIs compared with the male urogenital anatomy, particularly because the vaginal mucosa is thin, delicate, and easily penetrated by infectious agents (12). The cervix located at the distal end of the vagina connects to the upper genital tract, including the uterus, endometrium, fallopian tubes, and ovaries. STIs can cause a variety of symptoms and complications across different parts of the female reproductive tract, including genital ulcer disease, vaginitis, pelvic inflammatory disease, infertility, cervical cancer, and pregnancy complications (13), and drug resistance is a major threat to efforts aimed at reducing the burden of STIs worldwide (14).

Several studies demonstrated that STIs among women are associated with sociodemographic, socioeconomic, and geographic factors such as age groups, marital status, sex of household head, place of residence, education status, religion, and media exposure (15, 16).

To improve the quality of life and accomplish the goal of eradicating new HIV infections, the Ivory Coast government has endorsed a number of international commitments and strategies (17–20). However, while HIV prevention and treatment have received more public health attention in recent years than STIs, other STIs have received less attention. Although several studies have been conducted in the Ivory Coast to address this issue in different settings (19, 21–25), there is no updated and reliable national-level evidence on the factors associated with STIs among reproductive-age women. Furthermore, most of these studies lack representativeness, as they were conducted in specific regions rather than at the national level. Therefore, this study aimed to identify the factors associated with STIs among women in Ivory Coast at the national level using the Ivory Coast Demographic and Health Survey (DHS). Furthermore, policymakers and other stakeholders may prefer national-level findings, which serve as a foundation for designing and implementing appropriate intervention programs aimed at reducing the rate of STIs among women. In addition, this study also serves as a valuable reference for future research in this field.

The prevalence of STIs among women was 6.82% (95% CI: 6.42%, 7.23%) in the 12 months. This finding was lower than the studies which were conducted in Swaziland (19.4%) (28), eastern India (43.6%) (29), Ethiopia (16.7%) (30), Brazil (20.2%) (31), Uganda (26.0%) (32), and Tanzania (30%) (33). This finding was higher than the studies which were conducted in Hong Kong (2.5%) (34). The variations observed in the study could be attributed to several factors, including the study period, estimation method, sample size, socioeconomic status, and geographic location are the potential causes of these variations. This could be further explained by the fact that the cross-sectional study design may influence the results, as it captures the data at a single point in time and cannot establish causal relationships (35). However, the large sample size utilized in this study strengthens the finding by providing greater statistical power and ensuring a more representative analysis of the population (36). Additionally, participants’ cultural, educational, behavioral, and sociodemographic profiles may influence their health-seeking behaviors regarding STIs (STIs) (37). Furthermore, access to media and health facilities can also play a significant role, as these factors affect individuals’ awareness, knowledge, and ability to seek care (38).

The results of the multivariate analysis showed that among women, STIs were statistically and significantly associated with age group, marital status, religion, media exposure (listening to radio, watching television, and using the internet), history of a terminated pregnancy, contraceptive utilization, and being tested for HIV.

The findings of the study demonstrated that the odds of STIs between the ages of 20 and 34 were more likely compared to women whose ages were between 45 and 49 years old. This finding was concurrent with studies that were in sub-Saharan Africa (39), South Africa (40), Uganda (41), and Bangladesh (42). Young people are at a greater risk of acquiring STIs for several reasons. Young women are often sexually active and may engage in unsafe sexual behaviors, such as having multiple partners, sex without a condom, or sex under the influence of drugs or alcohol, which increases their vulnerability to STIs. Additionally, some young people do not undergo the recommended STI tests, and many are hesitant to discuss their sexual health openly and honestly with a doctor or nurse (43). Furthermore, women at this specific childbearing age (25–34 years) may have a higher coital frequency and have unprotected sex to meet the demands of having children (44, 45).

The odds of STIs among women who were living in Denguele, Montagnes, and Zanzan were more likely relative to women who were living in Abidjan. This might be due to the variations in healthcare facilities, health-seeking behaviors, access to media, socioeconomic and sociocultural factors, knowledge, attitude, and practice toward risky sexual behaviors across the regions, which contribute to the regional differences in STIs in Ivory Coast. This can be more explained by the fact that Abidjan, Ivory Coast's economic capital, has experienced significant urbanization, with its urban population reaching 53.1% in 2023. This urban growth has led to improved infrastructure and services, offering residents better access to healthcare, education, and employment opportunities. In contrast, regions like Denguele, Montagnes, and Zanzan remain less urbanized, facing challenges such as limited healthcare facilities and fewer educational institutions (46–48).

The likelihood of STIs was lower in Muslim women compared to women of other religions. This was supported by the studies that were conducted in Saudi Arabia (49), Since extramarital sex is forbidden in Islam, women believe that religion is protecting them from STIs, which also contributes to the low-risk perception (50–53). Low-risk perceptions about STIs among Muslim women contribute to the low prevalence of STIs due to underreporting, under-detection, and under-documentation of STIs. This could be further explained by Muslim women having poor knowledge regarding STI signs and symptoms, prevention, diagnosis, and treatment, in addition to many misconceptions; negative attitudes toward people infected with HIV/AIDS were common, and attitudes were highly influenced by misconceptions and insufficient knowledge. Women with STIs often face blame and judgment, which discourages them from seeking healthcare due to confidentiality concerns (54).

The odds of STIs among women who were married were less likely relative to women who were others (widowed, divorced, and no longer living together). This finding was in line with studies which were conducted in sub-Saharan Africa (55). This might be because societal norms and expectations related to marriage, which value fidelity and monogamy, are frequently linked to marriage. These social norms have the potential to discourage women from engaging in risky behavior by discouraging extramarital affairs (56). Those social norms, rooted in religious and social beliefs such as the principle of "no sex before marriage" have the potential to discourage women from engaging in risky behaviors like extramarital affairs, thereby contributing to a low incidence of sexually transmitted infections (STIs) among married women (56). Moreover, marriage can foster emotional closeness and fulfillment, which lessens the perception of the need to pursue satisfaction through risky extramarital sex.

The odds of STIs among reproductive-age women who listened to the radio at least once a week; watching television less than once a week; and using the internet almost every day were more likely relative to their counterparts. Were more likely relative to their counterparts. This might be that some media particularly internet-mediated platforms, including social media, video-sharing sites, and online forums, can expose adolescent women to sexually explicit content. This exposure may influence their attitudes, perceptions, and behaviors related to sexual activity, potentially leading to risky sexual behaviors such as early sexual initiation, unprotected sex, and multiple sexual partners (57). Therefore, raising awareness about the proper use of media, particularly internet platforms, could be a key strategy for reducing STIs among women (58–60). In contrast to this finding, several works of literature revealed that media exposure reduces the risks of STIs among women (61–63). This could be because the symptoms of most STIs are subtle and often undetected in women. Therefore, women who had media exposure could get better information and knowledge about STIs, which increases the rate of reporting STIs (64, 65) and early diagnosis of STIs. It offers the best opportunity for effective treatment, preventing complications and reducing the further transmission of STIs (66).

When compared to their counterparts, the likelihood of STIs was higher in women who had a history of a terminated pregnancy. This finding was in line with the studies which were conducted in Ethiopia (67), China (68), Ethiopia (69, 70), and Shandong province of China (71). The scientific explanation for this could be that having a history of abortion may increase women's susceptibility to sexually transmitted infections, especially when performed unsafely by unskilled or traditional practitioners without adherence to aseptic techniques, facilitating STI transmission (26, 72). Furthermore, this might be because the fact that those women who had a history of termination of pregnancy would have better access to reproductive health care services, sexual health services, and a better understanding of the symptoms of STIs, which prevents underreporting and underscreening of STIs and contributes to high detection rates of STIs among women who had a history of a terminated pregnancy.

The odds of STIs among women who use modern contraceptives were higher compared to women who did not use contraceptives. This finding was in line with the studies which were conducted in Bangladesh (42) and India (73). This may be because most contraceptive methods (non-barrier methods) are not highly effective in preventing both pregnancy and STIs. Furthermore, we speculated that many reproductive-age women perceive the risk of pregnancy to be higher than the risk of STIs. As a result, these women often use modern contraceptives, particularly emergency contraceptives, to prevent pregnancy but engage in unprotected or unsafe sexual activities, which contributes to the high incidence of STIs among women. Additionally, the inappropriate use of barrier methods, such as condoms, results in a 21%–40% failure rate in protecting against STIs (74).

STIs among women who were tested for HIV were more likely compared to women who were not tested for HIV. This finding was supported by the studies which were conducted in sub-Saharan Africa (75). Since most STIs are asymptomatic, the reasons for these variations might be that women who were tested for HIV might have more awareness about the symptoms of HIV and other STIs, which results in a high rate of screening and self-reporting of STIs. On the other hand, women who weren’t tested for HIV might not know their status results in low self-reporting of STIs.

This study found that nearly seven out of a hundred reproductive-age women in Ivory Coast had sexually transmitted infections, influenced by factors such as age group, region, religion, marital status, media exposures, history of a terminated pregnancy, and contraceptive utilization. Therefore, to reduce STIs among reproductive-age women, the governments of Ivory Coast and other concerned stakeholders should give special attention to women whose ages are between 20 and 34 years old, a highly risky region, promoting the media that were broadcasting STI prevention information and creating awareness about STIs for women who had a history of a terminated pregnancy and who used modern contraceptive methods.