Aim: To review the epidemiology of and data collection for sexually transmitted diseases (STDs) in South Africa.
Methods: Literature published since 1980 on STDs in South Africa were complied and evaluated. Historical reports and salient unpublished literature were also used in the literature review. Studies were critically reviewed in the light of sample populations and study methods, and a baseline picture of the patterns of STD burden was developed.
Results: The STD burden in apparently asymptomatic study populations is significant. Ulcerative infections, primarily caused by syphilis and chancroid, are present in 5-15% of asymptomatic clinic attenders; prevalence rates of gonorrhoea average 8%, with up to 13% of gonococcal isolates resistant to penicillin antibiotics. In addition, on average, chlamydia and vaginal infections are detected in 16% and 20-49%, respectively, of antenatal and family planning clinic attenders. HIV seroprevalence rates have reached 7.6% in antenatal clinic attenders. Most South African STD data are derived from ad hoc surveys which have traditionally focused only on several major infections and particular urban centres. Almost all STD studies have been facility-based, with many studies based at STD clinics, thus reporting only relative frequencies and not population-based prevalences of STDs. With the possible exception of HIV, systematic surveillance data for STDs are conspicuously lacking.
Conclusion: The disease burden of classic sexually transmitted infections has historically been heavy, and continues to be a serious public health problem in South Africa. Morbidity from both ulcerative and non-ulcerative infections, particularly in women, is significant. The body of STD data, although mostly sound, remains incomplete, and with the rapid emergence of HIV in South Africa, surveillance of STDs and focused STD policies will be critical.
PIP: Important unpublished literature and literature published since 1980 on sexually transmitted diseases (STDs) in South Africa were reviewed to provide a picture of what is known about the epidemiology of STDs in the country. STD infection is a serious public health problem in South Africa, with significant morbidity from both ulcerative and nonulcerative infections, particularly in women. The body of data on STDs was found to be largely sound, but incomplete. Ulcerative infections, caused mainly by syphilis and chancroid, are present in 5-15% of asymptomatic clinic attenders, while prevalence rates of gonorrhea average 8%, with up to 13% of gonococcal isolates resistant to penicillin antibiotics. Chlamydia and vaginal infections are detected in 16% and 20-49%, respectively, of antenatal and family planning clinic attenders. HIV seroprevalence has reached 7.6% among antenatal clinic attenders.