Sections

Prevention of Sexually Transmitted Infections

8.1 Overview

The risk of HIV-infection increases during sexual intercourse if one or both sexual partners have another sexually transmitted infection (STIs). Another common phrase used for essentially the same condition is sexually transmitted disease or STD. Common STIs include syphilis, gonorrhea and genital herpes.

The risk of HIV infection increases for two main reasons:

  • STIs usually cause ulcers or lesions on the surface area of the genitals giving the virus easier access to the bloodstream
  • Research shows that STIs can increase the number of CD4+ cells in the genital area, giving the HIV more target cells to attack (source)

Epidemiological studies have shown that people are 2-5 times more likely to contract HIV when other STIs are present.

The SA government's HIV/AIDS/STD strategic plan for South Africa (2000-2005) acknowledges the "compelling evidence of the importance of STDs as a major determinant of HIV transmission". There are approximately 11-million episodes of STIs annually in South Africa.

8.2 Prevention of STIs

The only way a person can 100% be sure they won't get an STI is if they abstain from sex.

People can reduce the risk of STI transmission by:

  • practicing safe sex and wearing a condom (although condoms sometimes do not cover affected regions around the genitalia)
  • not having multiple sexual partners
  • not having sex with people who have multiple sexual partners
  • discussing STIs openly with their sexual partner
  • not engaging in sexual intercourse while a sexual partner is being treated for an STI

8.3 Treatment of STIs

If STIs are not treated, they can cause infertility in men and women, premature birth and birth defects. Free STI treatment is available at most public health care providers, according to the South African health ministry.

Syndromic Management

In South Africa, "syndromic management" is often used to treat patients with STIs. Syndromic management is the identification and treatment of a disease or infection based primarily on the symptoms that it presents.

  • It allows for rapid care for patients on their first visit (no waiting for lab results)
  • The drugs prescribed often can treat multiple STIs
  • This type of health care can be administered by non-specialists, making access easier and the process less stigmatised
  • Emphasis is also placed on counselling and education for patients — WHO
Treating STDs Using The Syndromic Approach
Syndrome Treat for
Men Urethral discharge Gonorrhoea and Chlamydia
Women Lower abdominal pain Gonorrhoea, Chlamydia and
other bacteria
Vaginal discharge Cervicitis: Gonorrhoea and
Chlamydia Vaginitis:
Trichomoniasis and Candidiasis
Men or Women Genital Ulcers Syphilis, Chancroid and Genital
Herpes
Source: WHO. Syndromic Case Management of Sexually Transmitted Diseases

8.4 Studies

Key Research

A 1999 review of scientific literature on the relationship between HIV and STIs (also referred to as STDs) found that:

  • increased risk estimates ranged from 2.0 to 23.5, with most clustering between 2 and 5
  • "available data leave little doubt that other STDs facilitate HIV transmission through direct, biological mechanisms and that early STD treatment should be part of a high quality, comprehensive HIV prevention strategy"

In a trial in Mwanza, Tanzania, six communities in the region were offered STI treatment over two years. Six other communities were monitored.

  • The incidence of HIV infection was reduced by 38% in the group which was offered STI treatment

Other studies in Rakai, Uganda showed no effect on HIV incidence with STI treatment. However, researchers suggested that the maturity of the epidemic and the role of untreatable STIs played a large part in the ineffectiveness of the STI treatment on HIV transmission rates.