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The burden of asymptomatic sexually transmitted infections among men in Carletonville, South Africa: implications for syndromic management
  1. D A Lewis1,2,3,
  2. C Pillay1,
  3. O Mohlamonyane1,
  4. A Vezi1,
  5. S Mbabela1,
  6. Y Mzaidume4,
  7. F Radebe1
  1. 1
    Sexually Transmitted Infections Reference Centre, National Institute for Communicable Diseases (NHLS), Johannesburg, South Africa
  2. 2
    Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
  3. 3
    Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
  4. 4
    Mothusimpilo Project, Carletonville, South Africa
  1. Professor D A Lewis, STI Reference Centre, National Institute for Communicable Diseases, Private Bag X4, Sandringham 2131, South Africa; davidl{at}


Objectives: To determine the prevalence of sexually transmitted infections (STI) and HIV among men attending an outreach STI/HIV screening service in informal settlements in South Africa over a 3-month period.

Methods: A mobile clinic van was utilised to offer men: (1) urine screening for gonorrhoea, trichomoniasis, chlamydial and Mycoplasma genitalium infections; (2) serological screening for syphilis and herpes simplex virus type 2 (HSV-2); (3) on-site HIV voluntary counselling and testing. Urethritis pathogens were detected by molecular methods. HIV serostatus was determined using rapid tests. Demographic, sexual behaviour and clinical data were recorded on a nurse-administered questionnaire. Statistical analysis utilised the χ2 test.

Results: 309 men attended the service; 304 (98%) requested serological screening for syphilis and HSV-2, 301 (97%) underwent urine-based screening for urethritis pathogens and 269 (87%) had an HIV test. Over 90% of men were asymptomatic for STI. Gonorrhoea was more prevalent in the symptomatic group (p<0.001); there were no significant differences in the prevalence of other urethritis pathogens between the groups. The total number of infections with each urethritis pathogen was highest in the asymptomatic group with twice as much gonorrhoea, 25 times as much chlamydial infection, six times as much trichomoniasis and nine times as much M genitalium infection compared with the symptomatic group. The overall HIV prevalence among clinic attendees was 29.7%.

Conclusions: The uptake of both STI and HIV testing was high among men attending the service. The relatively high burden of both STI and HIV among the male clinic attendees has implications for the transmission of HIV.

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  • Funding: This study was supported by the United States Agency for International Development, Mission to South Africa, under the terms of the Equity in Integrated Primary Health Care (EQUITY) project grant agreement no 674-0320-G-00-5053, project implementation letter no 22.

  • Competing interests: None.

  • Ethics approval: Approval to conduct the study was granted by the Human Research Ethics Committee of the University of the Witwatersrand (protocol no M060333).

  • Contributors: DAL, OM, AV, SM and ZM set up the operational aspects of the study; OM, SM and AV were responsible for collection of the specimens at the field site; FR was responsible for laboratory-based STI testing; DAL and CP undertook the data analysis; DAL wrote the manuscript, which was reviewed by all the authors.

  • The opinions expressed herein are those of the authors and do not necessarily reflect the views of the United States Agency for International Development.