| Sumario: | Background: Adolescents in sub-Saharan Africa shoulder a disproportionate burden of sexually transmitted infections (STIs), yet data for pregnant teenagers in these settings are sparse. Objectives: The study estimated the prevalence of STI seropositivity and its associated factors, among pregnant adolescents at Mbarara Regional Referral Hospital (MRRH), Uganda. Design: Hospital-based cross-sectional study. Methods: Consecutive pregnant adolescents (10–19 years) attending the MRRH antenatal clinic or maternity ward between 1 July and 30 September 2024 were enrolled. A structured questionnaire captured socio-demographic, sexual-behavioural, obstetric, clinical and nutritional variables. Blood samples were tested for HIV (Determine™/STAT-PAK™), syphilis (Treponema pallidum haemagglutination assay) and Hepatitis B (HBsAg rapid test). The composite STI outcome was seropositivity for any infection: HIV, syphilis or HBsAg. Independent associations were examined with Firth-penalised logistic regression; adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. Results: Among 249 participants (median age 18 years, interquartile range 18–19), the overall prevalence of STI seropositivity was 12.1% (95% CI: 8.3–16.8). Prevalence by each STI was HIV 8.8%, syphilis 4.0% and HBV 0.4%. Multigravidae had higher odds of infection than primigravidae (aOR: 2.81, 95% CI: 1.01–7.84). Having ever used a non-barrier modern contraception tripled the odds of STI (aOR 3.04, 95% CI: 1.10–8.45), whereas marriage or cohabitation reduced risk by 63% (aOR 0.37, 95% CI: 0.14–0.96). Conclusion: Nearly one in eight pregnant adolescents at MRRH were infected with HIV, syphilis or HBV, with these STIs more likely to be among multigravidae and former users of non-barrier contraception and less likely among married/cohabiting pregnant adolescents. These findings support integrating repeat HIV–syphilis testing, dual-method contraceptive counselling and targeted interventions for multigravidae into youth-friendly antenatal services to advance STI-elimination goals. Plain language summary: Sexually transmitted infections among pregnant adolescents at Mbarara Regional Referral Hospital Pregnancy is a big step for any girl, and it can be harder if she carries a hidden sexually transmitted infection (STI), an infection that she may not see or feel. These hidden STIs: human immunodeficiency virus (HIV), syphilis and hepatitis B, can harm both mother and baby if they are not found and treated. From July to September 2024, we worked at Mbarara Regional Referral Hospital in south-western Uganda and obtained special information and small blood samples from 249 pregnant girls aged 10 to 19 years. We discovered that 30 of them (about one in every eight) had at least one infection: 22 had HIV, 10 had syphilis and one had hepatitis B. The likelihood of having these STIs was higher in girls who had been pregnant before compared to those who were pregnant for the first time. Girls who had ever used family-planning pills, injections or implants, methods that prevent pregnancy but do not block germs, also showed a three-times greater likelihood, possibly because condom use stopped after they changed to these methods. By contrast, girls who were married or living with one steady partner were less likely to be infected. In Uganda, most health centres test for HIV and syphilis only once, early in pregnancy, so new infections that appear later can be missed. Our findings recommend giving a second test later in pregnancy, teaching all girls to use condoms together with other family-planning methods, and paying special attention to adolescents who have been pregnant before. Finding and treating these hidden infections early will help teenage mothers deliver healthier babies and keep themselves safe for the future.
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