Research Article: Prevalence of sexually transmitted infections among young people in South Africa: A nested survey in a health and demographic surveillance site

Date Published: February 27, 2018

Publisher: Public Library of Science

Author(s): Suzanna C. Francis, T. Nondumiso Mthiyane, Kathy Baisley, S. Lerato Mchunu, Jane B. Ferguson, Theresa Smit, Tania Crucitti, Dickman Gareta, Siphephelo Dlamini, Tinofa Mutevedzi, Janet Seeley, Deenan Pillay, Nuala McGrath, Maryam Shahmanesh, Nicola Low

Abstract: BackgroundSexually transmitted infections (STIs) and bacterial vaginosis (BV) are associated with increased transmission of HIV, and poor reproductive and sexual health. The burden of STIs/BV among young people is unknown in many high HIV prevalence settings. We conducted an acceptability, feasibility, and prevalence study of home-based sampling for STIs/BV among young men and women aged 15–24 years old in a health and demographic surveillance site (HDSS) in rural KwaZulu-Natal, South Africa.Methods and findingsA total of 1,342 young people, stratified by age (15–19 and 20–24 years) and sex were selected from the HDSS sampling frame; 1,171/1,342 (87%) individuals had ≥1 attempted home visit between 4 October 2016 and 31 January 2017, of whom 790 (67%) were successfully contacted. Among the 645 who were contacted and eligible, 447 (69%) enrolled. Consenting/assenting participants were interviewed, and blood, self-collected urine (men), and vaginal swabs (women) were tested for herpes simplex virus type 2 (HSV-2), chlamydia, gonorrhoea, syphilis, trichomoniasis, and BV. Both men and women reported that sample collection was easy. Participants disagreed that sampling was painful; more than half of the participants disagreed that they felt anxious or embarrassed. The weighted prevalence of STIs/BV among men and women, respectively, was 5.3% and 11.2% for chlamydia, 1.5% and 1.8% for gonorrhoea, 0% and 0.4% for active syphilis, 0.6% and 4.6% for trichomoniasis, 16.8% and 28.7% for HSV-2, and 42.1% for BV (women only). Of the women with ≥1 curable STI, 75% reported no symptoms. Factors associated with STIs/BV included having older age, being female, and not being in school or working. Among those who participated in the 2016 HIV serosurvey, the prevalence of HIV was 5.6% among men and 19% among women. Feasibility was impacted by the short study duration and the difficulty finding men at home.ConclusionsA high prevalence of STIs/BV was found in this rural setting with high HIV prevalence in South Africa. Most STIs and HIV infections were asymptomatic and would not have been identified or treated under national syndromic management guidelines. A nested STI/BV survey within a HDSS proved acceptable and feasible. This is a proof of concept for population-based STI surveillance in low- and middle-income countries that could be utilised in the evaluation of STI/HIV prevention and control programmes.

Partial Text: In 2012, 286 million people aged 12–24 years lived in Africa, accounting for 18% of the global youth population. By 2040, the number of young people in Africa is projected to increase by 60% to 466 million [1]. Health interventions targeted at this age group are important for current and future adult health and for the health of the next generation. This is particularly true for sexually transmitted infections (STIs), which, when acquired in adolescence, can jeopardise sexual and reproductive health later in life and, for women, the health of their babies. In low- and middle-income countries (LMICs), symptomatic STIs are treated by syndromic management (presumptive treatment for symptomatic people without the use of laboratory tests) [2], but most STIs are asymptomatic and go unnoticed and untreated. Both symptomatic and asymptomatic STIs can cause serious morbidity, including pregnancy complications, cancer, infertility, and enhanced HIV transmission. Many of these sequelae are preventable if STI testing and treatment is implemented. Moreover, there is growing evidence that the common reproductive tract condition bacterial vaginosis (BV) is an independent risk factor for HIV [3,4], and BV-associated microbiota may decrease the efficacy of topical microbicides [5].

This study is reported as per the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (S1 STROBE Checklist) [14].

We conducted a nested STI survey among young people aged 15 to 24 years in a rural HDSS in KwaZulu-Natal, and found it to be feasible and acceptable. The HDSS provided infrastructure and a sampling frame to carry out a population-based cross-sectional study of STI/BV prevalence. There was a high burden of STIs/BV in this high HIV prevalence setting. Most of the infections were asymptomatic and would not have been identified or treated using national syndromic management guidelines.



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