The Specialist Forum Volume 13 No 11 November 2013 | Page 18

SEXUAL HEALTH

Sexually transmitted infections in SA
By Dr Rakesh Newaj, specialist dermatologist

F

or the past 15 years, there have been various measures put forward by the South African government to fight sexually transmitted
diseases. By far, the most prevalent STI has been HIV and a huge
amount of resources have been put forward for the prevention and treatment thereof. Others have been managed using a syndromic approach
and this has been fairly successful in most communities. Sexually transmitted infections are caused by intimate sexual contact with an infected
person. It can also occur from oral sexual contact or very rarely by using
common facilities. However, there are also some sexually transmittable
infections whereby non-sexual routes of transmission predominate and
sexual transmission is incidental.

Syndromic approach
Due to the fact that our infected patients tend to have more than one STI
at a time, the syndromic approach is still very effective in our context.
However, with the advent of the internet and more awareness campaigns,
patients do not only want to be treated, but also want to put a name to their
disease. They tend to get more satisfaction with the name of the disease
than from the treatment itself.
Thus there is an increased demand in serology testing for the common
STIs, which can be quite costly and the results can be ambiguous. An
accurate knowledge of the typical clinical presentation of various sexually
transmittable diseases can be very helpful and tends to put the patient
more at ease, even though the final treatment plan may still entail the use
of the syndromic management approach. Patients are very interested to
know the incubation period, the typical presentation and mode of transmission, probably because they want to pinpoint the event that led them
to inherit the disease. A few important facts that one should keep in mind
while treating somebody with a suspected STI:
• Up to 30% of patients with an STI may also be infected with HIV,
and thus they must be encouraged to get tested. The enzyme-linked
Table I: Common sexually transmitted and transmissible
pathogens
Bacteria

Chlamydia trachomatis
Neisseria gonorrhoeae
Haemophilus ducreyi
Trepanoma pallidum

i
­mmuno-sorbent assay or other confirmatory tests need to be done and
repeated after a period of time.
• A good history, though difficult to obtain, can be invaluable. Partners
need to be evaluated and treated as well.
• Not all rashes in the genital region are of infectious cause. There are
hundreds of skin diseases that can affect the anogenital region. Thus
we must have an open mind and if uncertain one has to be referred to
a skin specialist.
• A new and emerging problem seen more and more often at our clinics
is the psychological aspect that precedes an encounter or treatment of
STI’s, which can lead to diseases like STI phobias, vaginismus, penile
and/or vaginal pre-occupation.

Common STIs
Some of the most common STIs in SA will be discussed briefly with their
specific treatments.

Gonorrhoea
Gonorrhoea is still fairly commonly seen in our population, especially in
the low socio-economic regions. It is caused by bacteria called Neisseria
gonorrhoea which infects the mucous membranes of the human genital
tract (as well as the anus, rectum and mouth) after direct contact with the
mucosal surface of an infected person.
The incubation period is relatively short and it takes two to five days until
signs and symptoms appear. Up to 10% of infected men and 50% of infected women remain asymptomatic. The rest may have symptoms at the
site of infection or rarely disseminated disease that may cause systemic
complications. Most commonly there is a discharge from the genital tract.
Swabs of the discharge material can easily identify the bacteria on microscopy and thus treatment can be instituted. Systemic disease can be
confirmed with serology for N. Gonorrh