Research

Factors associated with repeat genital symptoms among sexually transmitted infection service attendees in South Africa, 2015 - 2016

R C Mathebula, L R Kuonza, A Musekiwa, R Kularatne, V Maseko, T Kufa

Abstract


Background. South African guidelines recommend a syndromic approach for the management of sexually transmitted infections (STIs), based on the presence of genital symptoms. However, the guidelines do not prescribe specific indications for microbiology testing for patients presenting with or without repeat genital symptoms.

Objectives. To describe the prevalence of and factors associated with repeat genital symptoms among STI service attendees at primary care facilities.

Methods. This was a cross-sectional study at 7 STI primary care facilities participating in the aetiological surveillance of STIs between January 2015 and December 2016. Demographic and clinical information and appropriate genital specimens were collected from participants presenting with vaginal discharge syndrome (VDS), male urethral syndrome (MUS) and/or genital ulcer syndrome (GUS). Repeat genital symptoms were defined as self-reported history of the same STI-related genital symptoms in the preceding 12 months. Multivariable logistic regression identified factors associated with repeat genital symptoms.

Results. Of 1 822 eligible participants, 480 (30%) had repeat genital symptoms (25% and 75% in the preceding 3 months and 12 months, respectively). Of those with repeat genital symptoms, the median age was 28 (interquartile range (IQR) 24 - 32) years, and 54% were females. The most common aetiological agents among participants with VDS, MUS and GUS were bacterial vaginosis (n=132; 55%), Neisseria gonorrhoeae (n=172; 81%) and ulcers (n=67; 63%), respectively. One hundred and seven (20%) participants had no detectable common STI aetiology. In the multivariable analysis, repeat genital symptoms were associated with HIV co-infection (adjusted odds ratio (aOR) 1.43; 95% confidence interval (CI) 1.14 - 1.78), VDS diagnosis (aOR 1.39; 95% CI 1.10 - 1.76), self-reported condom use (aOR 1.56; 95% CI 1.20 - 2.03) and age 25 - 34 years (aOR 1.33; 95% CI 1.03 - 1.71).

Conclusions. Our study found a high prevalence of repeat genital symptoms ‒ a significant proportion without STI aetiology. Identified factors of repeat genital symptoms highlight the need for improved integration of HIV and STI prevention and management. Further research is needed to determine the aetiology of repeat genital symptoms and the contribution of non-STI causes.


Authors' affiliations

R C Mathebula, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria; and South African Field Epidemiology Training Programme (SAFETP), National Institute for Communicable Diseases, Johannesburg, South Africa

L R Kuonza, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria; and South African Field Epidemiology Training Programme (SAFETP), National Institute for Communicable Diseases, Johannesburg, South Africa

A Musekiwa, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria; and South African Field Epidemiology Training Programme (SAFETP), National Institute for Communicable Diseases, Johannesburg, South Africa

R Kularatne, Centre for HIV and STI, National Institute for Communicable Diseases, Johannesburg; and Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

V Maseko, Centre for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa

T Kufa, Centre for HIV and STI, National Institute for Communicable Diseases, Johannesburg; and School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Full Text

PDF (188KB)

Keywords

Sexually transmitted infections; Syndromic management; Repeat genital symptoms; Persistent; Recurrent; STI aetiology

Cite this article

South African Medical Journal 2020;110(7):661-666. DOI:10.7196/SAMJ.2020.v110i7.13998

Article History

Date submitted: 2020-07-07
Date published: 2020-07-07

Article Views

Abstract views: 901
Full text views: 995

Comments on this article

*Read our policy for posting comments here