Know your STATUS

South Africa is fast trying to combat the spread of sexually transmitted infections, especially among vulnerable young women, writes Craig Bishop

TECH-SAVVY YOUNGSTERS are using social media platforms to dive straight into a “hook-up” culture, and this is driving the opportunistic spread of sexually transmitted diseases.

That is the sobering warning from a range of public health experts, who urge anyone who is pregnant or thinking about starting a family, to get tested for sexually transmitted infections (STIs). You might think that you’re not infected, but these opportunistic diseases can often lie dormant in your body for years, according to medical experts.

ONLINE DATING IS PART OF THE PROBLEM

According to one article from online news site VOX, health experts increasingly view Apps and sites such as Tinder, Grindr, and OkCupid as “enablers of high-risk sex, helping people meet and hook up more efficiently than ever before. The impact of these sites is so profound they’re also transforming the way health officials track and prevent outbreaks”. Moreover, although you might dismiss concerns about STIs because they can be treated with antibiotics, many people are unaware that having an STI increases the likelihood that you’ll develop HIV too.

A SERIOUS PUBLIC HEALTH ISSUE

STIs are a serious public health issue.

Worldwide, around a million people are diagnosed with gonorrhoea, chlamydia or syphilis every day. South Africa has one of the highest rates of STIs in the world. And the statistics for young people, aged between 18 to 24 are alarming, especially in rural areas, according to figures from the National Institute for Communicable Diseases (NICD).

Part of the problem is implementing strategies that empower young women to control their reproductive rights, and educating families how best to address such sensitive issues, according to a report from the Desmond Tutu HIV Foundation at the University of Cape Town. For example, adolescent girls and young women acquire HIV at twice the rate of their male peers. A similar trend is true for STIs.

There are around eight million people living with HIV/Aids in South Africa. In 2017 there were an estimated 2.3 million new cases of gonorrhoea, 1.9 million new chlamydia cases, and 23 175 new syphilis cases among women aged between 15 and 49. Among men of the same age there were an estimated 2.2 million new cases of gonorrhoea, 3.9 million new cases of chlamydia and 47 500 new cases of syphilis.

In Gauteng alone, new STI treatedepisodes doubled from 205 960 in 2015 to 465 944 in 2016. Male urethral syndrome infections – which cause abdominal pain and pain when urinating – doubled from 55 021 in 2015 to 104 720 in 2016.

LONG-TERM PROBLEMS

Senior epidemiologist at the Centre for HIV and STIs, Dr Tendesayi KufaChakezha, says that STIs are spread mainly through sexual contact, and can have devastating effects on sexual, reproductive and general health. They can also lead to a number of complications. “If left untreated, chlamydia and gonorrhoea can cause damage to reproductive organs and result in long-term complications such as infertility. People can even die if certain STIs such as syphilis are left untreated, or if they have complications such as pelvic inflammatory disease in the case of chlamydia.”

TRANSMISSION

STIs may be transmitted from mother to baby either via the placenta during pregnancy, or during the baby’s passage through the birth canal at delivery. Untreated STIs can result in adverse pregnancy outcomes:

SYPHILIS: stillbirths, preterm labour, low birth-weight babies, and congenital syphilis disease in babies and children. HIV: low birth weight babies, childhood developmental delay, other infections as the immune system of the child is impaired.

GONORRHOEA, CHLAMYDIA: eye infection of the baby soon after birth, pneumonia in the infant. Clinical microbiologist, Dr Ranmini Kularatne, from the Johannesburgbased Centre for Centre for HIV & STIs within the NCID, warns that pregnant women are not routinely screened for STIs such as gonorrhoea and chlamydia during pregnancy. “This may happen in future as rapid, accurate and affordable screening tests that are currently in development are validated for use and become readily available. STI in the mother may also increase the risk of acquiring HIV infection. Elimination of mother-to-child transmission of syphilis and HIV is a global and national health priority,” Dr Kularatne says.

Until then, it is important to follow some simple guidelines to ensure your health and your baby’s health.

PREVENTION

Learn more about STIs, symptoms and signs, where to get diagnosis and treatment, how the diagnosis is made, what treatments there are.

› Use of condoms. Negotiating the use of condoms with sexual partners › Reducing number of sexual partners › Seeking early treatment for any abnormal sores in the genital area or any genital discharge

› Completing or adhering to treatment provided

› Referring and making sure sexual partners are treated

Dr Kufa Chakezha says that South Africa needs to renew its focus on STI prevention. “Strategies to prevent STIs must take into account the changes and advances in HIV prevention and treatment. Policies must answer a number of questions. For instance, how can having fewer sexual partners, the correct and consistent use of condoms, the early STI detection and treatment of oneself and one’s partners, and male circumcision be made ‘fashionable’ when HIV is not the death sentence that it used to be?

“And what’s the best way to communicate that the knowledge of infections in oneself and the partner are key to preventing both HIV and other STIs?” he says.

Dr Kufa Chakezha urges government to explore how best to design prevention services that communicate how STIs and HIV happen within short-term or longer relationships. “Policy makers need to understand, too, how people can be empowered to form, maintain or terminate relationships in a manner that does not place them in harm’s way with respect to HIV, STIs or intimate partner violence. All of these issues must be urgently considered if South Africa is to tackle its STI problem as effectively as it’s been able to deal with HIV,” he says.

If left untreated, chlamydia and gonorrhoea can cause damage to reproductive organs and result in longterm complications such as infertility. People can even die if certain STIs such as syphilis are left untreated, or if they have complications such as pelvic inflammatory disease in the case of chlamydia