Page 79 - University of Pretoria RESEARCH REVIEW 2018

Fighting sexually transmitted diseases
in resource-constrained settings
Remco Peters, Department of Medical Microbiology, and Anova Health Institute
The World Health Organization estimates that more than a million sexually transmitted infections (STIs) are acquired every day. While some STIs, such as HIV and Human Papillomavirus (HPV), are incurable, other bacterial STIs can be detected and treated, provided there is ongoing surveillance and screening. Since many patients have asymptomatic infections, screening as a first step is vital.
Remco Peters from the Anova Health Institute, and an extra- ordinary professor at the Department of Medical Microbiology at UP,
has highlighted the importance of screening and treating STIs at the primary healthcare level. Working
in the Mopani district in Limpopo, Peters and his research team, which includes Nireshni Naidoo (University
of the Witwatersrand) and Kate Rees (University of Cape Town), have found that almost half of women visiting mobile clinics have an STI, a much higher prevalence than previously observed at primary healthcare facilities. By deploying mobile clinics in remote areas that have few primary healthcare facilities, and by working closely with community health workers, the team was able to find many more women who needed treatment.
Their findings, published in PLOS One and the Southern African Journal of
HIV Medicine, highlight the challenges regarding access to care in remote areas, which contribute to the sustained high burden of STIs in deep-rural areas. Moreover, molecular analysis of some bacterial infections, specifically Chlamydia trachomatis
(CT) and Mycoplasma genitalium (MG) infections, showed a well-established
genetically diverse epidemic indicating ongoing transmission. Drug resistance, however, was uncommon.
In a similar study in the Tshwane municipality, conducted in partnership with the Foundation for Professional Development, Peters and his team assessed the prevalence of STIs among pregnant women who
were infected with HIV, using the GeneXpert platform for STI testing performed at a primary healthcare facility. Their research, published
in the journal Sexually Transmitted Diseases, showed that nurses were reliable users of this platform to test for STIs, and to provide patients with
a same-day result. Pregnant women were reportedly satisfied to wait for their test results, and subsequently
to receive appropriate and targeted treatment. In Tshwane, approximately 40% of pregnant women tested positive for an STI, received their results in the same day, and were treated within seven days.
Professor Peters maintains that as
the high burden of STIs contributes
to negative pregnancy outcomes, screening and testing for STIs should be routine for women, and form part of holistic community-based health care.
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