A diagnosis of male urethritis syndrome is an indicator of newly acquired sexually transmitted infections, particularly gonorrhea and chlamydia, which are the most prevalent sexually transmitted infections in South Africa, according to the Gauteng Department of Health.
- Sexually transmitted diseases are on the rise again in South Africa and around the world.
- The Gauteng Department of Health recently reported an increase in newly acquired sexually transmitted infections, particularly gonorrhea and chlamydia.
- At least one expert says the surge will require a review of management guidelines and awareness programs.RT.
Increase in the number of sexually transmitted disease cases reported in Gauteng in 2023 is a wake-up call that control and management strategies are not keeping up with the growing disease burden in South Africa's most populous province, Spotlight reports ing.
“The information from Gauteng confirms the rise in sexually transmitted infections not only in South Africa but around the world, including the United States and Canada,” said Dr Nomasemba Chandiwana, Director and Chief Scientist of the Edinsha Research Center at Wits University. Stated. She is also a co-author of her 2022 Guidelines for the Management of Sexually Transmitted Infections produced by the South African Association of HIV Clinicians.
Mr Chandiwana said the rise in sexually transmitted diseases should sound an alarm because it meant “things we thought were under control are no longer under control”.
In 2022, the World Health Organization (WHO) said countries reported low coverage of prevention, testing and treatment-related services due to Covid-19 lockdown restrictions.
The WHO acknowledged that this had led to a “resurgence of sexually transmitted diseases and the emergence of non-classical sexually transmitted diseases.” [such as Shigella sonnei, hepatitis A, Neisseria meningitidis, Zika and Ebola] It also reported that there are currently more than 1 million new sexually transmitted infections infected every day around the world, “posing a significant global health problem.”
Starting in mid-2023, WHO is promoting easier access to low-cost, point-of-care testing in low- and middle-income countries, which will improve screening and diagnosis, data collection, and make STI services more effective. I think it will happen.
South Africa does not have such tests available and remains reliant on a syndromic approach, a clinical diagnosis made by assessing a patient's symptoms and other visible signs.
Chandiwana said there is a need for a review of guidelines for the treatment and management of sexually transmitted infections, as the rising number of infections poses a new and serious public health threat.
Emerging public health threats
Of particular concern is that contracting a sexually transmitted disease not only increases the risk of contracting HIV, a “chronic and serious disease,” but also other long-term or irreversible medical conditions, including reproductive complications. She said it poses a real risk.
In early February, the Gauteng Department of Health reported that the incidence of male urethritis syndrome (MUS) among men aged 15 to 49 in the province had increased from 12% in 2020 to 15% in 2023. . The agency did not disclose the actual figures. This comparison is complicated somewhat by the fact that 2020 saw strict coronavirus lockdowns and restrictions in place.
According to the department's 2023 information, between 167 and 109 men between the ages of 15 and 49 visited health care facilities in the state between April and December. Of these patients, 67,400 (40% of 167,109) were treated for MUS.
A diagnosis of MUS is an indicator of newly acquired sexually transmitted infections, particularly gonorrhea and chlamydia, which are the most prevalent sexually transmitted infections in South Africa, according to the Gauteng Department of Health.
Thousands of men and women have been found infected in health facilities in Gauteng.
Infograph by Spotlight based on information provided
Chandiwana said the diagnosis of MUS in men and pelvic inflammatory disease (PID) in women was made by assessing symptoms of pain, discomfort, genital discharge and sores. Traditionally, it has been treated with broad-spectrum antibiotics.
She explained that South Africa's treatment and management guidelines are to make clinical decisions based on the patient's symptoms and signs.
“This standard approach is working, but we are calling for a move toward targeted diagnostics and targeted treatments. It's about knowing which STI someone has and wanting to treat that specific disease.” ,” Chandiwana said.
Different STIs have different complications. Syphilis, for example, can cause women to give birth to children who are deaf or blind, and can increase the risk of infertility, she said. (Spotlight previously reported more about congenital syphilis in South Africa here.)
Read | Increase in sexually transmitted disease patients: “I slept with more than 6 girls this month alone”
“There are also asymptomatic sexually transmitted infections that are present but invisible, such as HPV (human papillomavirus), which is the leading cause of cervical cancer among black women in South Africa,” Chandiwana said.
“Of course, this is complicated by the fact that testing services are not universally available in the public health system, and even when tests are conducted, results take a long time.”
what will you do
This means that a multifaceted approach is necessary. This must include a shift away from stigmatizing and policing people's sexual behavior, she said. Her comments were echoed in the same Gauteng Department of Health press release by Gauteng Health and Wellness MEC Nomantu Nkomo, who the MEC drew a link to the number of women coming forward to start pre-exposure prophylaxis (PrEP). This was in response to Mr. Lalejoko's statement. ) – an antiretroviral drug prescribed to her HIV-negative person to stop HIV infection – and a higher number of her STIs have been recorded.
The MEC reportedly said:
We believe that the high uptake of PrEP among women led this group to engage in unprotected sex, resulting in a higher incidence of MUS. Studies have also reported higher rates of STIs among young women receiving PrEP.
Mr. Chandiwana rejected the conclusion of causation. “PrEP is a really important tool because it's something that people can take to prevent HIV. But before PrEP was introduced, people weren't like using condoms; People weren't using anything. So I disagree. The proliferation of PrEP is not directly related to HIV infections. It's an increase in sexually transmitted infections,” she said.
What we need instead is why people don't use condoms more often, and why South Africa is tackling sexually transmitted infections, including differentiated care for key groups such as sex workers, men who have sex with men, and people who have sex. She said the question is why not create disease-friendly services? Inject medicine.
We also need more peer navigators, fast, efficient and confidential services, and investment and development of rapid test kits, she added.
Preliminary findings from the 6th South African National HIV Prevalence, Incidence and Behavior Survey, published by the Human Sciences Research Council in November, show a significant decline in condom use among young people from 2017 to 2022. showed that.
That prompted a call for Nkomo-Ralehoko to take more PrEP.
“We want to encourage more men to start PrEP to protect themselves from sexually transmitted infections. In addition, both men and women on PrEP can help protect themselves from sexually transmitted infections, HIV, and “You should use condoms to protect yourself from pregnancy,” she reportedly said. press release.
The role of medical male circumcision
Meanwhile, NGO Right to Care is promoting voluntary medical male circumcision as another strategy to combat the rise in sexually transmitted infections.
“Uncircumcised men are more susceptible to sexually transmitted infections than circumcised men, especially sexually transmitted infections that cause ulcers and sores,” said Nelson, a senior technical expert in the NGO Voluntary Medical Male Circumcision.・Dr. Igaba said.
Read more | Gauteng launches campaign to protect girls from cervical cancer after spike in sexually transmitted diseases
He said the Gauteng statistics were “alarming” and should be read as an encouragement for more men to choose circumcision. The NGO connects the men to the nearest public facility where they can receive free surgery. (Contact number: 082 808 6152.)
Dr. Tendesai Kufa Chakeza, a senior epidemiologist at the Center for HIV and Sexually Transmitted Diseases at the National Institute of Infectious Diseases (NICD), also points out the need for further awareness.
Also read | Statistics show that young people are giving up condoms.
“As a country, we don't talk enough about sexually transmitted infections, both among ourselves and with our children. We need more health workers, and we need more training. We also need a massive campaign to educate the community about the causes, symptoms, and symptoms of sexually transmitted infection syndromes.'' Where to get treatment, types of treatment, complications, and symptoms. We also decided whether to return to the facility if the condition does not improve,” she said.
Kufa Chakeza said South Africa's sexually transmitted disease treatment guidelines are in line with existing WHO guidelines. He said the NICD regularly collects information and specimens from health care facilities, which allows it to identify the most common causes associated with the most commonly seen symptoms.
NICD uses these findings to inform national STI management and treatment strategies based on the diagnosis and treatment of the most prevalent STIs.
“As a country, if we cannot get more people tested and treated, whether they have STI symptoms or not, we will continue to get STIs, develop associated symptoms, and get sick. There will continue to be people who develop complications,” she added.
