Unrecognized sexually transmitted infections in rural South African women

A hidden epidemic

D. Wilkinson*, S. S. Abdool Karim, A. Harrison, M. Lurie, M. Colvin, C. Connolly, A. W. Sturm

*Corresponding author for this work

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Sexually transmitted infections (STIs) are of major public health concern in developing countries, not least because they facilitate transmission of human immunodeficiency virus (HIV). The present article presents estimates of the prevalence, on any given day, of STIs among women in rural South Africa and the proportion who are asymptomatic, symptomatic but not seeking care, and symptomatic and seeking care. The following data sources from Hlabisa district were used: clinical surveillance for STI syndromes treated in health facilities, microbiological studies among women attending antenatal and family planning clinics, and a community survey. Population census provided denominator data. Adequacy of drug treatment was determined through quality of care surveys. Of 55 974 women aged 15-49 years, a total of 13 943 (24.9%) were infected on any given day with at least one of Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, or Treponema pallidum. Of the women investigated, 6697 (48%) were asymptomatic, 6994 (50%) were symptomatic but not seeking care, 238 (1.7%) were symptomatic and would seek care, and 14 (0.3%) were seeking care on that day. Only 9 of the 14 women (65%) were adequately treated. STIs remained untreated because either women were asymptomatic or the symptoms were not recognized and acted upon. Improved case management alone is therefore unlikely to have a major public health impact. Improving partner treatment and women's awareness of symptoms is essential, while the potential of mass STI treatment needs to be explored.

Original languageEnglish
Pages (from-to)22-28
Number of pages7
JournalBulletin of the World Health Organization
Volume77
Issue number1
Publication statusPublished - 1999
Externally publishedYes

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