Barriers and Factors Associated With Disclosure of Chlamydia trachomatis Infection Among Sexually Active Individuals in Buea, Cameroon: A Cross‐Sectional Study

ABSTRACT

Background

Chlamydia trachomatis remains a major global public health concern, particularly among sexually active adolescents and young adults. Disclosure of an infection to sexual partners is essential for effective management and reduction of onward transmission; however, barriers to disclosure and communication persist.

Objective

This study assessed the proportion of participants willing to disclose a positive Chlamydia trachomatis result, the barriers to disclosure, and the factors associated with intended disclosure among sexually active individuals in Buea.

Methods

This community‐based, mixed‐methods cross‐sectional study was conducted from February to April 2024 among 253 participants aged ≥ 15 years recruited through convenience sampling. Structured questionnaires and in‐depth interviews captured sociodemographic characteristics, sexual behaviours, and perceived disclosure barriers. Quantitative data were analysed using descriptive statistics, Chi‐square tests, and multivariable logistic regression, while qualitative data were analysed thematically. Analyses were performed using SPSS version 26.0, with statistical significance set at p < 0.05.

Results

The participants' mean age was 24.2 years (SD = 4.85); most were female (64.0%) and single (89.3%). Overall, 68 participants (26.9%) indicated that they would not disclose a positive Chlamydia result, corresponding to approximately one in four participants. Major barriers included anxiety (13.1%), lack of communication (6.1%), fear of stigma, and anticipated negative partner reactions. Participants who anticipated a violent partner reaction were significantly less likely to disclose (AOR = 0.259, 95% CI: 0.109–0.615, p = 0.002), as were those who were uncertain about their partner's reaction (AOR = 0.401, 95% CI: 0.171–0.943, p = 0.036). Females had higher odds of intended disclosure than males (AOR = 1.93, 95% CI: 1.072–3.475, p = 0.028). Casual sex and inconsistent condom use were not significantly associated with intended disclosure.

Conclusion

Intended disclosure of Chlamydia trachomatis infection was constrained by psychosocial and relational barriers in Molyko. Interventions should prioritise stigma reduction, partner communication support, and community‐based education to improve disclosure practices and reduce transmission among populations at risk.

Abbreviations

AOR

Adjusted Odds Ratio

CI

Confidence Interval

COR

Crude Odds Ratio

HIV

Human Immunodeficiency Virus

IRB

Institutional Review Board

LMICs

Low‐ and Middle‐Income Countries

PN

Partner Notification

SPSS

Statistical Package for the Social Sciences

SSA

Sub‐Saharan Africa

STD

Sexually Transmitted Disease

STI

Sexually Transmitted Infection

1. Background

Chlamydia trachomatis is one of the most prevalent bacterial sexually transmitted infections (STIs) globally and represents a substantial public health burden, particularly among sexually active adolescents and young adults [1, 2]. Chlamydial infection is often asymptomatic, especially in women, leading to underdiagnosis, delayed treatment, and an increased risk of complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility [3, 4].

In 2020, an estimated 128.5 million new Chlamydia trachomatis infections occurred globally, with prevalence estimates of 4.0% among women and 2.5% among men aged 15–49 years. The burden remains particularly high in sub‐Saharan Africa, where prevalence was estimated at approximately 6.9% among females and 4.2% among males [5]. Chlamydial infection is endemic in Cameroon, with reported prevalence estimates of ≥ 10% [6]. University students and other young adults are among the populations most affected by STIs [6]. In low‐ and middle‐income countries, including those in sub‐Saharan Africa, the burden of C. trachomatis remains disproportionately high [5, 6].

Management of C. trachomatis in Africa often relies on syndromic approaches, which lack the sensitivity to detect asymptomatic cases, unlike systematic screening programs currently implemented in many high‐income nations [6]. Consequently, complications and onward transmission persist at elevated levels in these regions.

Partner notification and treatment are critical components of STI control because they interrupt transmission and reduce the risk of reinfection [7]. For bacterial STIs such as Chlamydia trachomatis, partner notification, also referred to as contact tracing, facilitates the identification, testing, and treatment of exposed sexual partners. It therefore supports individual case management while helping to prevent repeated infection and onward transmission within sexual networks.

Disclosure of an STI diagnosis to sexual partners is, therefore, a cornerstone of effective case management and ethical sexual practice [6, 7]. However, the act of disclosure is fraught with psychosocial complexities. Studies consistently identify multiple barriers, including fear of stigma, blame, and relationship dissolution, anxiety about partner reactions (including intimate partner violence), and a lack of communication skills or self‐efficacy [8, 9]. These barriers can lead to non‐disclosure, where individuals choose to conceal their status, thereby undermining public health efforts and potentially exacerbating personal psychological distress [10].

Data on partner notification and barriers to disclosure of Chlamydia trachomatis infection remain limited in Cameroon. This study therefore assessed the proportion of participants willing to disclose a positive result, the perceived barriers to disclosure, and the factors associated with intended partner notification.

2. Methodology

2.1. Study Design and Setting

This study used an explanatory sequential, mixed‐methods, community‐based cross‐sectional design that combined quantitative and qualitative approaches to provide a comprehensive understanding of Chlamydia trachomatis disclosure in the target population. The study was conducted in Molyko, a health area in the Buea Health District and the capital of the Southwest Region of Cameroon [11]. Buea hosts the University of Buea, which enrols a large student population, as well as several private higher‐education institutions in the Southwest Region.

2.2. Study Duration and Sample Size

This study was conducted between February and April 2024.

Cochran's formula was used to estimate the minimum sample size [12].

$$n0=\frac{Z2\mathit{pq}}{e2}$$

Where:

Z = 1.96, corresponding to a 95% confidence level and a 5% type I error

p = expected prevalence

e = margin of error (5%)

Confidence level = 95%

q = 1 − p

The sample size estimation was informed by a previously reported Chlamydia trachomatis prevalence of 23.04% among individuals attending Mbouo‐Banjoun Hospital in Cameroon [12].

n₀ = 272

2.3. Sampling Procedure

The study site was selected purposively. Within Molyko, eligible participants were recruited using convenience sampling. Individuals of reproductive age who provided consent and met the inclusion criteria were enrolled.

2.4. Study Population

The target population comprised sexually active residents of Molyko, Buea. This population was selected due to the sexually transmitted nature of Chlamydia trachomatis and the high concentration of young adults in Molyko, driven by the presence of the University of Buea and several private institutions. This setting is associated with increased social interaction and sexual network connectivity, which may elevate the risk of transmission.

2.5. Inclusion Criteria

• 1.Participants who provided informed consent, or assent where applicable, after receiving a comprehensive explanation of the study procedures were included.
• 2.Eligible participants were self‐reported sexually active individuals, defined as those who had engaged in vaginal, anal, or oral sexual activity within the preceding 24 months.
• 3.Participants had to be able to read and adequately understand the questionnaire, study information, and interview guide.

2.6. Exclusion Criteria

• 1.Pregnant women and participants who were receiving treatment for Chlamydia trachomatis infection were excluded to minimise potential confounding of prevalence estimates and risk‐factor analyses.
• 2.Participants who were unable to provide informed consent due to cognitive impairment, severe illness, or inability to understand study procedures were excluded.

2.7. Data Collection Tools

Data were collected using a structured questionnaire that captured sociodemographic characteristics, sexual behaviours and risk factors, and perceived disclosure barriers, together with a qualitative in‐depth interview guide.

2.8. Participant Enrolment

Participant enrolment followed ethical principles and was entirely voluntary. After enrolment, participants completed the questionnaire and were offered testing for Chlamydia trachomatis. Recruitment was conducted through house‐to‐house visits across Molyko, temporary campaign stations established on selected days, and fixed testing sites at Mayor Street, Diligent Care, and Malingo, which participants could attend at their convenience.

2.9. Training and Pretesting

Five data collectors were trained in Good Clinical Practice, human‐subject protection, data‐quality procedures, and accurate survey administration. The principal investigator monitored their adherence weekly. The questionnaire was pretested among 20 consenting participants from the Bonduma community, assessed for comprehension, and refined before deployment in the study population.

2.10. Quantitative and Qualitative Data Collection Procedures

Following informed consent, trained interviewers administered a structured questionnaire capturing sociodemographic characteristics, sexual behaviours, risk factors, and disclosure barriers. Each participant was assigned a unique identifier, which was recorded in the enrolment register (Figure 1).

Figure 1.

Data collection procedure.

The structured questionnaire was administered through face‐to‐face interviews by trained interviewers. Privacy and confidentiality were maintained to encourage honest responses and uphold standards for the protection of human participants.

In‐depth interviews were conducted with consenting participants using a structured interview guide to explore perceptions and experiences related to disclosure of Chlamydia trachomatis infection. Interviews continued until thematic saturation was reached. Audio recordings were transcribed, and the transcripts were manually coded using a tabular framework to identify statements about disclosure and retesting barriers. Codes were organised into themes and subthemes based on similarity (Table 1), and the findings were presented with illustrative quotations from participants.

Table 1.

Qualitative thematic framework for the in‐depth interviews.

Meaning units	Codes	Sub‐categories	Generic categories
‐Feeling anxious	‐Anxiety	‐Emotional response to	‐Psychological
‐Worried about Partner reaction	‐Worry	Disclosure	Barriers
‐Concern about damaging the relationship	‐Relationship concerns	‐Impact on relationship	‐Social Barriers
Trust in partner	‐Trust level	‐Interpersonal trust	‐Relational
‐Fear of judgment	‐Fear of judgement	‐Anticipated stigma	Dynamics
‐Risk of breakup	‐Risk of breakup	‐Negative relationship outcomes	‐Stigma and Judgement
Fear of conflicts	Fear of conflicts	Conflict avoidance	Communication barriers
Lack of knowledge on how to disclose	Lack of knowledge	Need for guidance	Information barriers
Negative past experiences leading to fear	Negative past experiences leading to fear	Learned fear	Learned Barriers
Concerns about stigma and privacy	Stigma and privacy concerns	Social implications	Societal barriers

2.11. Data Management

Data were entered into Google Forms, exported to Microsoft Excel, and cleaned before analysis. The dataset was checked for completeness, validity, and consistency. Hard‐copy questionnaires were stored in a secure, access‐restricted location to maintain confidentiality and prevent data loss. Electronic data were backed up in the study team's email accounts and on a password‐protected USB drive.

2.12. Data Analysis

Quantitative data were analysed using the Statistical Package for the Social Sciences (SPSS), version 26.0 (IBM Corp., Armonk, NY, USA). Means and standard deviations were calculated for continuous variables, while frequencies and percentages were used for categorical variables. Associations between categorical variables were assessed using the Chi‐square test at a 5% significance level. Logistic regression was performed as appropriate, and multivariable logistic regression was used to estimate the independent associations of sociodemographic characteristics, sexual behaviours, and other factors with intended disclosure while adjusting for potential confounders. Qualitative transcripts were analysed thematically, as described above.

2.13. Ethical Considerations

Administrative clearance was obtained from the Head of the Department of Public Health and Hygiene (Ref: 2024/056/UB/HOD/PHH/FHS). Ethical approval was obtained from the University of Buea Faculty of Health Sciences Institutional Review Board (Ref: 2024/2421‐02/UB/SG/IRB/FHS). Authorisation to conduct the study was subsequently obtained from the Molyko community representative following an advocacy meeting.

3. Results

A total of 253 participants were enrolled in the quantitative component. The mean age was 24.22 years (SD = 4.85), with participants ranging from 18 to 52 years.

3.1. Proportion of Participants Willing to Disclose

Figure 2 presents participants' intended disclosure following a hypothetical positive diagnosis. Of the 253 participants, 68 (26.9%) indicated that they would not disclose the result to their sexual partner, whereas 185 (73.1%) indicated that they would disclose a positive result.

Figure 2.

Proportion of study participants willing to disclose a positive Chlamydia result. DisclosurePos: intended disclosure of a positive Chlamydia result.

3.2. Barriers to Disclosure of Chlamydia trachomatis Infection

Figure 3 presents the reported reasons for non‐disclosure or perceived difficulties with disclosure. Among participants who had never been tested for Chlamydia, 69.7% reported multiple reasons for anticipated non‐disclosure, 13.1% identified anxiety as a major barrier, and 6.1% identified lack of communication about STIs. A statistically significant association was observed between perceived reasons for non‐disclosure among previously negative participants and overall Chlamydia prevalence (p < 0.05).

Figure 3.

Reasons for non‐disclosure or barriers to disclosure of Chlamydia trachomatis infection in Molyko, Buea, 2024. L. comms: lack of communication; Educ/Know: education/knowledge, Neg: Negative.

3.3. Factors Associated With Intended Disclosure of a Positive Chlamydia Test Result

Table 2 presents factors associated with intended disclosure following a positive Chlamydia trachomatis test. In the bivariate analysis, participants who reported communication about STIs had higher odds of disclosure (COR = 1.56; 95% CI: 0.89–2.76; p = 0.123), although the association was not statistically significant. After adjustment for potential confounders, participants who reported discussing STIs had lower odds of disclosure (AOR = 0.36; 95% CI: 0.16–0.81; p = 0.014).

Table 2.

Factors associated with intended disclosure of a positive Chlamydia status: bivariate and multivariable analyses.

95% CI (Bivariate analysis)						95% CI (Multivariate)
Variable	Category	COR	Lower	Upper	p‐value	AOR	Lower	Upper	p‐value
DiscloViolence	Yes	0.826	0.462	1.476	0.518	—	—	—	—
	No	1
CommsSTI	Yes	1.564	0.886	2.759	0.123	0.364	0.163	0.813	0.014
	No	1				1
PartnerAcuCheat	No	1.644	0.843	3.206	0.144	1.24	0.96	2.68	0.164
	I don't know	1.298	0.542	3.108	0.558	0.98	0.236	1.312	0.063
	Yes	1				1
PartReactPos	Violent/Physical Reaction	0.248	0.106	0.582	0.001	0.259	0.109	0.615	0.002
	Relationship termination/mistrust	0.33	0.118	0.919	0.034	0.396	0.139	1.126	0.082
	I don't know	0.391	0.167	0.915	0.030	0.401	0.171	0.943	0.036
	Supportive	1				1
HistoryChlamPos	Yes	1.617	0.78	3.351	0.196	1.695	0.792	3.628	0.174
	No	1				1	—	—	—
ManagePartin	Yes	1.722	0.901	3.29	0.100	1.553	0.792	3.044	0.2
	No, just the infected partner	1				1
Health Source	Dispensaries/Pharmacies	1.06	0.87	1.97	0.999		—	—	—
	Hospital	2.2	0.91	2.15	0.999	—	—	—	—
	Traditional doctor/herbalist	1			—	—	—	—	—

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; CommsSTI, communication about STIs; COR, crude odds ratio; HistoryChlamPos, history of Chlamydia positivity; ManagePartin, partner involvement in management; PartReactPos, anticipated partner reaction to a positive result; PartnerAcuCheat, partner accusation of cheating.

Perceived partner reaction was significantly associated with intended disclosure. Participants who anticipated a violent or physical reaction were less likely to disclose (AOR = 0.26; 95% CI: 0.11–0.62; p = 0.002). Similarly, participants who were uncertain about their partner's reaction had lower odds of disclosure (AOR = 0.40; 95% CI: 0.17–0.94; p = 0.036).

Table 3 shows that sex was significantly associated with intended disclosure. In the adjusted analysis, females had higher odds of disclosure than males (AOR = 1.93; 95% CI: 1.07–3.47; p = 0.028). The bivariate association was also statistically significant (COR = 0.53; 95% CI: 0.30–0.93; p = 0.027).

Table 3.

Sociodemographic factors associated with intended disclosure of a positive Chlamydia status.

95% CI (Bivariate analysis)						95% CI (Multivariate Analysis)
Variable	Category	COR	Lower	Upper	p‐value	AOR	Lower	Upper	p‐value
Age group	> 35	1.385	0.318	6.026	0.665	—	—	—	—
	15–19	1.938	0.513	7.319	0.329	—	—	—	—
	20–24	2.295	0.905	5.816	0.080	—	—	—	—
	25–29	1.569	0.552	4.461	0.398	—	—	—	—
	30–34	1
Gender	Female	0.527	0.299	0.929	0.027	1.93	1.072	3.475	0.028
	Male	1				1
Marital status	Single	1.294	0.115	14.519	0.835	—	—	—	—
	Married	2.5	0.18	34.669	0.495	—	—	—	—
	Co‐habiting	1
Education	Tertiary	0.923	0.436	1.952	0.833	—	—	—	—
	Secondary	1
Parity	Uniparous	0.96	0.256	3.598	0.951	—	—	—	—
	Nulliparous	1.677	0.538	5.231	0.373	—	—	—	—
	Multiparous	1
Occupation	Employed	0.527	0.123	2.266	0.390	0.551	0.127	2.394	0.427
	Private sector	3.143	0.45	21.958	0.248	3.736	0.523	26.702	0.189
	Self‐employed	1.429	0.326	6.257	0.636	1.416	0.318	6.313	0.648
	Student	1.868	0.521	6.699	0.338	1.713	0.469	6.255	0.415
	Unemployed	1

Note: Bold values indicate statistical significance.

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio.

Table 4 presents the associations between sexual‐behavioural factors and intended disclosure. Age at sexual debut, condom use, reasons for condom non‐compliance, casual sex, and previous STI diagnosis were not significantly associated with disclosure (all p > 0.05). Participants who reported casual sex had higher odds of intended disclosure (AOR = 1.69; 95% CI: 0.91–3.11), but this association was not statistically significant (p = 0.095).

Table 4.

Sexual‐behavioural factors associated with intended disclosure of a positive Chlamydia status.

	95% CI (Bivariate analysis)					95%CI (Multivariate analysis)
Variable	Category	COR	Lower	Upper	p‐value	AOR	Lower	Upper	p‐value
Sex debut	15–19	0.652	0.151	2.824	0.568	—	—	—	—
	> 20	0.437	0.09	2.115	0.303	—	—	—	—
	< 15	1
Condom use	Rarely	0.57	0.261	1.244	0.158	0.584	0.266	1.281	0.179
	On most occasions	0.536	0.233	1.231	0.141	0.536	0.231	1.242	0.146
	Never	0.536	0.2	1.437	0.215	0.540	0.2	1.458	0.224
	Always	1				1
Condom non‐compliance	Reduces sexual enjoyment	0.937	0.163	5.399	0.942	—	—	—	—
	Pregnancy risk	0.931	0.159	5.446	0.937	—	—	—	—
	None	2.16	0.39	11.956	0.378	—	—	—	—
	Multiple reasons	0.964	0.165	5.649	0.968	—	—	—	—
	Irritations	0.75	0.081	6.958	0.800	—	—	—	—
	Blind trust	0.947	0.176	5.113	0.950	—	—	—	—
	Anxiety	1					1
Casual sex	Yes	1.557	0.858	2.826	0.146	1.686	0.913	3.114	0.095
	No	1				1
STI diagnosis	Yes	0.662	0.288	1.523	0.332	0.607	0.257	1.433	0.255
	No	1

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio.

3.4. Qualitative Analysis of Disclosure Barriers

3.4.1. Psychological Barriers to Disclosure

Participants reported substantial psychological barriers to disclosing a Chlamydia infection. These included shame and embarrassment, fear of judgement and stigma, and anxiety about negative reactions from partners and peers. Concerns about the effects of disclosure on relationships and self‐esteem contributed to reluctance or avoidance. The emotional burden of concealing an infection also intensified stress and isolation. One participant summarised these concerns as follows:

We really want to disclose, but we worry about how our partners will feel, the mental image they will have of us, and the future of our relationship. This fear of the unknown, especially regarding our partners' reactions, is a major barrier.

(TP06, TP08, TP15, TP19, and TP20)

3.4.2. Social Barriers to Disclosure

Participants described several social barriers to disclosing a Chlamydia infection. Low levels of trust within relationships made disclosure difficult because participants feared negative or unsupportive reactions. Fear of judgement from partners and peers also discouraged disclosure, particularly when participants anticipated being blamed for the infection. The possibility of relationship dissolution was another major concern and added to the emotional and social burden of managing the condition.

Contracting Chlamydia is often associated with suspicions of infidelity. The news may spread through partners, leading to feelings of low self‐esteem, possible relationship breakdown, and heightened mistrust and guilt, even if the relationship endures.

(Multiple participants)

3.4.3. Communication Barriers

Participants reported that communication barriers substantially hindered disclosure of a Chlamydia infection. A primary concern was the potential for conflict following disclosure. Many participants anticipated arguments, misunderstandings, or confrontation with their partners. Fear of these outcomes made them hesitant to initiate discussions about a diagnosis and encouraged avoidance of the topic.

I have hardly ever discussed STIs with my partner; this makes me completely uncertain about the possible outcome of the conversation.

(TP02–TP04, TP11, TP19, TP20, and TP22)

3.4.4. Negative Past Experiences

Participants identified negative past experiences as an important barrier to disclosing a Chlamydia infection. Within the subcategory of learned fear, several participants recounted previous disclosures that had resulted in rejection, ridicule, violence, or breaches of confidentiality. These experiences created apprehension about repeating similar encounters and discouraged future disclosure, thereby perpetuating silence and secrecy. One participant described the experience as follows:

I have previously tested positive for STIs, including gonorrhoea and syphilis. The disclosure led to severe physical assault; I was hospitalised, and the relationship ended. I therefore see disclosure as a dead end.

(Female, 27 years, TP09; male, 22 years, TP17; and TP16)

4. Discussion

The findings contribute to understanding the psychosocial context of intended Chlamydia trachomatis disclosure among sexually active individuals in Buea, Cameroon. Effective partner notification and treatment are essential because untreated partners may reintroduce infection into an ongoing sexual partnership or leave other partners within a sexual network untreated [13].

Among participants, 73.1% indicated that they would disclose a positive diagnosis, suggesting substantial awareness of the importance of partner notification for Chlamydia trachomatis. However, 26.9% indicated that they would conceal the result, and the qualitative findings highlighted persistent barriers. The observed willingness to disclose was higher than the 56% reported in a study from the Netherlands [14]. Differences between settings may reflect sociocultural context, relationship dynamics, access to sexual‐health information, and the degree to which STI discussions are normalised. In many African settings, STI‐related stigma remains strong, and infections may be interpreted as evidence of infidelity or moral wrongdoing. Comprehensive sexuality education and open parent–adolescent communication may also be limited because of concerns that such discussions could encourage early sexual activity.

Multiple barriers to intended disclosure were identified, including fear of violence, poor partner communication, anxiety, anticipated negative reactions, low self‐esteem, suspicions of infidelity, and negative past experiences. Studies in Ethiopia and Tanzania have similarly reported that fear of relationship dissolution and embarrassment can hinder partner notification and delay treatment [15, 16]. The qualitative findings showed that disclosure decisions were strongly shaped by anticipated social consequences and previous adverse experiences. These results indicate that disclosure is not solely an individual health decision but is embedded within relationship dynamics and broader sociocultural expectations.

The multivariable analysis further demonstrated the importance of psychosocial and relational factors. Anticipation of a violent partner reaction, uncertainty about a partner's reaction, communication about STIs, and sex were significantly associated with intended disclosure. These findings are consistent with research from Cameroon and other African settings in which stigma, fear, and relationship dynamics have emerged as important barriers [17]. Gender differences may reflect broader social norms that impose different expectations and consequences on men and women regarding sexual behaviour and disclosure. Interventions to improve Chlamydia control should therefore integrate biomedical, behavioural, and sociocultural strategies.

Sex was significantly associated with intended disclosure, consistent with evidence from Nigeria identifying gender and violence as important predictors of partner notification [17]. Although participants who reported casual sex had higher adjusted odds of intended disclosure, this association did not reach statistical significance. Relationship type may nevertheless influence perceived responsibility to notify a partner, and this possibility warrants further investigation in adequately powered studies.

Anticipated partner reactions strongly influenced disclosure decisions. Participants feared that disclosure could lead to accusations of infidelity, hostility, violence, or relationship dissolution, thereby threatening their social standing and emotional well‐being. Previous research has similarly shown that individuals may wish to prevent onward transmission but remain reluctant to disclose because of anticipated relationship consequences [18]. The consistency of these findings across settings may reflect the importance of relationship dynamics among young and sexually active populations.

The qualitative findings complemented the quantitative results by illustrating the emotional and psychological dimensions of disclosure. Fear of being labelled unfaithful, mistrust, communication difficulties, and negative past experiences showed how decisions were shaped by both current relationships and prior events. For some participants, disclosure was perceived as a “dead end,” reflecting learned fear after adverse experiences. Similar themes have been reported in Ethiopia, Tanzania, and Nigeria [15, 16, 19], suggesting that stigma, mistrust, and communication barriers are common regional challenges.

Casual sex and inconsistent condom use were not significantly associated with intended disclosure, which is consistent with findings from other studies [20]. This suggests that participants may recognise the importance of disclosure even when psychosocial barriers prevent action. In addition, reliance on syndromic management in many African settings may miss asymptomatic infections and may not adequately incorporate partner‐notification strategies [21, 22, 23, 24]. Integrated, culturally sensitive interventions are therefore needed to address both structural and psychosocial barriers to STI management and disclosure.

4.1. Study Limitations

The cross‐sectional design precludes causal or temporal inferences between the identified factors and intended disclosure. Convenience sampling in one predominantly young community in Molyko also limits generalisability to other populations in Buea, Cameroon, and comparable settings. In addition, the primary outcome measured participants' stated intention to disclose a hypothetical positive result rather than verified disclosure following a confirmed diagnosis; stated intentions may not translate into actual behaviour. Nevertheless, integration of the quantitative and qualitative findings provides useful context for understanding barriers to intended Chlamydia trachomatis disclosure.

5. Conclusion

Although 73.1% of participants indicated that they would disclose a positive Chlamydia result, approximately one in four reported that they would not disclose. Intended disclosure of Chlamydia trachomatis infection was constrained by psychosocial, relational, and sociocultural barriers. Interventions that reduce stigma, strengthen partner communication, address the risk of violence, and support patient‐centred partner notification are needed to improve disclosure practices and reduce STI transmission in similar settings.

Author Contributions

Pride Tanyi Bobga: conceptualization, methodology, data curation, investigation, validation, formal analysis, funding acquisition, project administration, writing – original draft, visualization, resources. Njouendou Abdel Jelil: supervision, writing – review and editing, resources, data curation, visualization. Dickson Shey Nsagha: writing – review and editing. Fabrice Ambe Ngwa: project administration, visualization. Raiye Andrel Dzon ETOU: methodology, writing – review and editing. Bianpambe Ousmaila Ignagali: writing – review and editing, data curation. Arrey Tabe Michael: project administration, writing – review and editing, data curation. Bime Melissa Jane Siben: writing – review and editing, resources. Jane‐Francis Tatah Kihla Akoachere: supervision, methodology, validation.

Funding

The authors have nothing to report.

Disclosure

All authors have read and approved the final version of the manuscript. Dr Tanyi Pride Bobga had full access to all study data and assumes responsibility for the integrity of the data and the accuracy of the analyses.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

Dr. Tanyi Pride Bobga affirms that this manuscript is an honest, accurate, and transparent account of the study.

Data Availability Statement

The data supporting the findings of this study are available from the corresponding author upon reasonable request.