About two million South Africans were treated for sexually transmitted infections (STIs) in primary health care clinics in 2002, according to the country’s first national assessment of STI services in the public sector, due to be released in Gauteng today (4 Feb).

However, the new research estimates that approximately 8.4 million people over the age of 15 contracted a sexually transmitted infection (STI) in 2002. This is based on the fact that a number of STIs are asymptomatic, particularly in women, and a high proportion of people seek private treatment for STIs.

While this is substantially lower than previous estimates of around 11 million, it still means that about 28% of South Africans over the age of 15 are infected with STIs every year.

This is a serious health problem, particularly as the presence of other STIs enhances HIV transmission. People with other STIs, particularly those that cause sores on the genitals, are at higher risk as it it easier for the virus to get into their bodies.

The research, conducted by the Reproductive Health Research Unit (RHRU) and the national and provincial departments of health, was gathered from telephonic interviews with senior staff at a quarter of all primary health care facilities (962 facilities), as well as site visits and simulated client visits between July 2002 and March 2003.

The survey also found that that only half of nurses working at primary health care clinics had been trained in the “syndromic management” of STIs, which involves treating patients according to their symptoms rather than on the basis of laboratory testing.

In addition, only 41% of facilities gave correct drug treatments for the various STIs. Correct treatment for genital ulcers was particularly low. Incorrect treatment means that resources are wasted and there is a greater danger of drug resistance.

Health workers from the Eastern Cape and Gauteng were among the most accurate with treatment, which shows that the intensive training being given to the Eastern Cape’s health staff is paying off.

Very few of the simulated clients who visited facilities reporting symptoms of STIs were actually examined, although drugs were given to them. This is likely to be related to staff shortages and lack of training.

On the positive side, only 6% of facilities reported shortages of STI drugs during July 2002, and only 4% ran out of male condoms.

There was a higher proportion of female to male clients in all provinces. This indicates that men, who are more likely to show symptoms than women, are seeking treatment in the private sector. This supports other surveys which show that men tend to seek private treatment for STIs.

There was generally poor uptake of HIV services on offer, particularly HIV counselling and testing. On average, 20 people a month were tested at facilities offering HIV testing. Most tests were done in KwaZulu-Natal and the Western Cape and most tended to be on pregnant women.

Interestingly, the health department’s promotion of female condoms seems to have been very successful with 80 000 distributed during July 2002. Findings from the survey showed that female condom distribution has expanded beyond the designated sites. Some 8,7-million male condoms were distributed during the same period.

The researchers recommend that there needs to be better integration of STI, HIV, family planning and antenatal services to maximise accessibility to STI services.

They also recommend that health workers need more training in clinical and counselling skills.

e-mail Kerry Cullinan