There’s been a five-fold rise in the number of infections in five years
Kevin Scott
Genital herpes is rocketing in South Africa with the number of infections quintupling over the last five years. Nearly 30% of South Africans have at least one sexually transmitted infection (STI), and half of those so afflicted are thought to have herpes.
To raise awareness of the silent epidemic, next week has been designated National STI Week. Doctors suggest that the damage caused by STIs could be one reason why HIV/Aids is blazing its way through South Africa. Having a genital infection makes people up to eight times more likely to catch HIV.
The rise of herpes is particularly worrying because it is a chronic and incurable disease. The disease has wreaked havoc worldwide; once making the cover of Time magazine.
Herpes is also one of the most painful STIs, producing recurring bouts of boil-like sores and lacerations. Infection in women is particularly problematic, since they can transmit the virus to their children. Doctors often prefer to do a caesarean on herpes-infected women to reduce the chances of the child being infected as it squeezes its way down the birth canal.
Research by Professor Wim Sturm, head of medical microbiology at the University of Natal, has found that just over a third of women in KwaZulu-Natal have at least one STI a figure he believes is representative of the country as a whole. “KwaZulu-Natal seems to prompt trends in the rest of the country,” says Sturm.
Research by the Medical Research Council puts the figures even higher. Dr Mark Colvin says nearly half of all women attending antenatal clinics in KwaZulu-Natal have at least one STI and that a quarter have two or more infections simultaneously.
Apart from herpes, the most common STIs are trichmononiasis, syphilis and gonorrhoea. All are relatively easily treated with antibiotics, but if untended cause serious illnesses and, sometimes, infertility.
Doctors refer to sexually transmitted infections (STIs) rather than diseases (STDs) to reflect the fact that so many can be asymptomatic. Up to 80% of women may contract syphilis without showing any symptoms.
Professor Hendrik Koornhof, acting head of the STI Reference Centre at the National Health Laboratory Services in Johannesburg, says that this is one area where going to a public medical facility can be better for your health than going private. The public health sector has kept up with modern medical theory such as treating infected patients for more than one disease at a time. Such syndomic treatment has proved most effective in knocking back bacterial diseases like syphilis and gonorrhoea.
Many general practitioners and private clinics diagnose the specific STI which has driven their patient to the consulting rooms. However this is a costly and lengthy process. In the public sector a patient with one STI is automatically given treatment for the most common other infections a practice which has a dramatic affect on STIs and is more cost effective.
Koornhof cites the Lesedi project in the Free State, where “periodic presumptive treatment” saw an 85% fall in common, curable STIs in nine months. This relied on infection levels so high that treatment was justified on presumption of infection.
“We don’t try to target people, we try to target behaviour,” says Koornhof. The project targeted sex workers regularly visited by miners.
Routine annual examinations revealed that gonorrhoea was down by 43% and genital ulcers down by 78%.
There is debate over whether such an approach will work on a countrywide basis. Sturm, for one, rejects the notion that there is a “high risk” group and says there is no core group of people suffering. “It [STI] is a general problem, not specific,” he says.