Opportunities for treating sexually transmitted infections and reducing HIV risk in rural South Africa

Fröhlich, Janet A.; Karim, Quarraisha Abdool; Mashego, May.; Sturm, A. Willem; Karim, Salim S Abdool

doi:10.1111/j.1365-2648.2007.04405.x

Cited by 19 publications

(5 citation statements)

References 32 publications

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“…Median size of study population was 448 participants (range: 100–6514). Characteristics of 88 studies reporting on prevalence in women recruited in the general community, 20,52–69 at PHC settings 6,7,19,35,70–104 and FSWs 105…”

Section: Resultsmentioning

confidence: 99%

Genital Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in sub-Saharan Africa: A structured review

et al. 2018

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Chlamydia trachomatis and Neisseria gonorrhoeae constitute major public health problems among women, but the burden of infection in sub-Saharan Africa is poorly documented. We conducted a structured review of the prevalence and incidence of genital, oral and anal C. trachomatis and N. gonorrhoeae infection in women in sub-Saharan Africa. We searched Medline, EMBASE and Web of Science over a 10-year period for studies on epidemiology of genital, oral and anal chlamydial infection and gonorrhoea in women in all countries of sub-Saharan Africa. We assessed geographic and demographic differences in prevalence and incidence of infection; weighted mean prevalence estimates were calculated with a random-effect model. A total of 102 study results were included, with data available for 24/49 of sub-Saharan countries. The weighted prevalence of chlamydial infection was lower among women in community-based studies (3.9%; 95% CI: 2.9-5.1%) than for women recruited at primary healthcare facilities (6.0%; 95% CI: 4.2-8.4%, p < 0.001); the same was observed for gonorrhoea (2.2%; 95% CI: 1.2-4.0% vs. 4.2%; 95% CI: 3.2-5.6%, p < 0.001). Prevalence of Chlamydia among sex workers was 5.5% (95% CI: 4.2-7.3%) and gonorrhoea 7.6% (95% CI: 5.4-11%). Seven studies reported on incidence which varied between 0.75-28 and 2.8-17 per 100 person-years-at-risk for chlamydial infection and gonorrhoea, respectively. Only two studies reported on anal infections and one on oral infection. This overview underscores the considerable incidence and prevalence of genital C. trachomatis and N. gonorrhoeae in women in different settings in sub-Saharan Africa. Better control strategies are warranted to reduce the burden of infection and to prevent long-term complications of these infections.

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Section: Resultsmentioning

confidence: 99%

Genital Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in sub-Saharan Africa: A structured review

et al. 2018

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“…Gonorrhea and chlamydia prevalence data used, and adjustments for diagnostic test performance and missing high-risk populations, and for chlamydia for age, in the Spectrum-STI prevalence trend estimation for 15–49 year-old adults, South Africa. With references: [ 32 , 46 , 50 , 51 , 72 , 77 , 80 , 81 , 86 , 91 – 93 , 95 , 98 – 116 ].…”

Section: Supporting Informationmentioning

confidence: 99%

Adult gonorrhea, chlamydia and syphilis prevalence, incidence, treatment and syndromic case reporting in South Africa: Estimates using the Spectrum-STI model, 1990-2017

et al. 2018

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ObjectivesTo estimate trends in prevalence and incidence of syphilis, gonorrhea and chlamydia in adult men and women in South Africa.MethodsThe Spectrum-STI tool estimated trends in prevalence and incidence of active syphilis, gonorrhea and chlamydia, fitting South African prevalence data. Results were used, alongside programmatic surveillance data, to estimate trends in incident gonorrhea cases resistant to first-line treatment, and the reporting gap of symptomatic male gonorrhea and chlamydia cases treated but not reported as cases of urethritis syndrome.ResultsIn 2017 adult (15–49 years) the estimated female and male prevalences for syphilis were 0.50% (95% CI: 0.32–0.80%) and 0.97% (0.19–2.28%), for gonorrhea 6.6% (3.8–10.8%) and 3.5% (1.7–6.1%), and for chlamydia 14.7% (9.9–21%) and 6.0% (3.8–10.4%), respectively. Between 1990 and 2017 the estimated prevalence of syphilis declined steadily in women and men, probably in part reflecting improved treatment coverage. For gonorrhea and chlamydia, estimated prevalence and incidence showed no consistent time trend in either women or men. Despite growing annual numbers of gonorrhea cases − reflecting population growth − the estimated number of first line treatment-resistant gonorrhea cases did not increase between 2008 and 2017, owing to changes in first-line antimicrobial treatment regimens for gonorrhea in 2008 and 2014/5. Case reporting completeness among treated male urethritis syndrome episodes was estimated at 10–28% in 2017.ConclusionSouth Africa continues to suffer a high STI burden. Improvements in access and quality of maternal, STI and HIV health care services likely contributed to the decline in syphilis prevalence. The lack of any decline in gonorrhea and chlamydia prevalence highlights the need to enhance STI services beyond clinic-based syndromic case management, to reinvigorate primary STI and HIV prevention and, especially for women, to screen for asymptomatic infections.

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“…In South Africa, young women continue to be the most vulnerable group for HIV and other sexually transmitted infections ( Wand & Ramjee, 2015 ). Despite intensive prevention and treatment efforts these rates have steadily increased over the years ( Frolich et al 2007 ; Wilkonson et al 1998 ; Hoque, 2011 ). There are several factors that may increase a young women’s risk for HIV and other STIs.…”

Section: Discussionmentioning

confidence: 99%

Correlates of Sexually Transmitted Infections Among South African Women Using Individual- and Community-Level Factors: Results from Generalized Additive Mixed Models

et al. 2019

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South Africa has the highest burden of Human Immunodeficiency Virus (HIV) infections in the world. There is also growing evidence that an individual’s risk of contracting HIV is increased by the presence of other sexually transmitted infections (STIs). Primary objective of this study was to examine the association between the prevalence of STIs in a cohort of South African women who enrolled in HIV prevention trials (2002–2012). The current study linked the individual-factors with the community-level characteristics using geo-referencing. This multi-level data was analysed in generalized additive mixed models (GAMMS) settings. In the multivariate logistic regression model, younger age [Odds Ratio (OR):4.30, 95%CI: 3.20, 5.77 and OR:2.72, 95% CI: 2.02, 3.66 for age<25 and 25–29, respectively]; being single/not cohabiting (OR:4.57, 95% CI: 3.18, 6.53), two+ sex partners (OR:1.46, 95% CI: 1.18,1.80); parity<2 (OR:2.04, 95% CI: 1.53, 2.72 ), parity=2 (OR:1.85, 95% CI: 1.37, 2.48), and using injectables (contraceptive) (OR:1.53, 95%CI: 1.13, 2.06) were all significantly associated with increased prevalence of STIs. Besides these individual-level characteristics, women who resided in the communities where high proportions of: female headed-households (OR: 1.17, 95%CI: 1.02, 1.38), and no schooling (OR: 1.26, 95%CI: 1.08, 1.45). Because, these factors may reflect characteristics of the larger groups who share similar cultural norms and social environments, they can provide considerable insight into the spread of STIs. Prevention strategies based on individual and community-level drivers of STIs are likely to be the most effective means of targeting and reaching those at greatest risk of infection. This strategy has the potential to play a significant role in the epidemic’s trajectory.

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Opportunities for treating sexually transmitted infections and reducing HIV risk in rural South Africa

Abstract: Nurse-driven antenatal and family planning services provide a useful opportunity for integrating reproductive health services, human immunodeficiency virus voluntary counselling and testing and treatment of sexually transmitted infections.

Cited by 19 publications

References 32 publications

Genital Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in sub-Saharan Africa: A structured review

Genital Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in sub-Saharan Africa: A structured review

Adult gonorrhea, chlamydia and syphilis prevalence, incidence, treatment and syndromic case reporting in South Africa: Estimates using the Spectrum-STI model, 1990-2017

Correlates of Sexually Transmitted Infections Among South African Women Using Individual- and Community-Level Factors: Results from Generalized Additive Mixed Models

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