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

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.

Asymptomatic Bacterial Vaginosis in Pregnancy and Missed Opportunities for Treatment: A Cross-Sectional Observational Study

“…In our cohort of HIV uninfected pregnant women, none of the behavioural characteristics iterated in the above studies were associated with BV. The high BV prevalence in the 19-to 24-year-old pregnant women is consistent with a South African rural community survey of nonpregnant women but the BV prevalence in the younger nonpregnant women was higher (41.1%) than that reported for our periurban pregnant population in the same age group (32.8%) [24].…”

“…The high prevalence of BV (37.3%; 95%CI 33.9-40.9) in this HIV uninfected pregnant population in South Africa is consistent with other sub-Saharan African pregnant populations (Zimbabwe 32.6%, Zambia 48.3%) [20,21] and other South African studies of nonpregnant women at risk for HIV acquisition [22][23][24]. Our study is the first large cohort study of 750 HIV uninfected pregnant women of all ages attending primary health care clinics in a high HIV burden subdistrict of KwaZulu-Natal.…”

Trends and Predictors of Sexually Transmitted Infections Among Sexually Active Ugandan Female Youths: Evidence from Three Demographic and Health Surveys, 2006-2016

“…In this study, we found that the prevalence of STIs among youths was high, with the highest prevalence found among youths 20-24 years old. This is consistent with several studies (21)(22)(23)(24)(25) showing that the prevalence of STIs was higher among young people aged 20-24 years compared to those 15-19 years. Surprisingly, the prevalence of STIs in 2011 is strikingly higher than in other years.…”

Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study

“…The risk of acquiring HIV also increases in the presence of sexually transmitted infections (STIs), with the majority of STIs occurring in young people under 25 years of age [8][9][10]. The estimated prevalence of STIs in South Africa among female clinic or community populations aged 15 to 24 years old was 20.6% for chlamydia, 8.9% for gonorrhoea, 20.0% for trichomoniasis, 53.7% for HSV-2, and 52.4% for bacterial vaginosis [11].…”