Background. In South Africa STI care is provided at primary healthcare (PHC) facilities using syndromic management. For various reasons, individuals with STI-associated symptoms may not access these services, resulting in a hidden burden of untreated disease. We used a comprehensive approach to mobilise these individuals for STI care by a visiting expert team on two consecutive days. Mobilisation was done over a period of two weeks through clinic posters, trained community health workers, and empowered traditional leaders. 

Methods. This study was conducted at three PHC facilities in rural Mopani District, South Africa. Symptomatic (discharge and/or dysuria) adult individuals visiting the facility on one of the designated days were asked to participate. A questionnaire was completed, physical examination conducted, and specimens (urine, vaginal swab) were collected for molecular detection of the most common STIs and microbial culture.

Results. We enrolled 108 individuals (81 women; 75%) in this study. Based on the catchment population of the three PHC facilities, we estimate that at least 1:240 individuals have untreated STI-associated symptoms. Most individuals were mobilised through the clinic poster (52%) followed by community health workers (30%), friend (13%) and traditional leader (5%). The main reasons reported for not accessing care were: unawareness of symptoms (31%), recurrence (24%) or persistence (18%) of symptoms, and issues related to healthcare staff (11%). An STI was detected in 73/108 (68%) individuals; Trichomonas vaginalis (56%) was the most common pathogen followed by Chlamydia trachomatis (18%), Neisseria gonorrhoeae (7%) and Mycoplasma genitalium (6%). Bacterial urethritis was diagnosed in 21 (19%) individuals. Enterobacteriaceae were most commonly isolated; almost all isolates were resistant to amoxicillin. 

Conclusion. We demonstrate that for various reasons there is a concerningly large burden of symptomatic STIs in rural South Africa. Community mobilisation approaches can be successfully deployed to (re)engage these individuals with healthcare services.

COMMUNITY APPROACHES TO SUCCESSFULLY ADDRESS THE HIDDEN BURDEN OF SEXUALLY TRANSMITTED INFECTIONS IN RURAL SOUTH AFRICA