Southern African HIV Clinicians Society 2022 guideline for the management of sexually transmitted infections: Moving towards best practice

Abstract

Sexually transmitted infections (STIs) are among the most common acute conditions worldwide with sub-Saharan Africa ranking among the regions with the highest burdens globally.1 Adolescent girls and young women (AGYW), people living with HIV (PLHIV), pregnant women, and key and vulnerable populations are disproportionally affected by STIs. The social determinants of health, gender inequality, and STI-associated stigma and discrimination (at both the community and facility level) are important contributors to the sustained high burden of infection. Some STIs cause urogenital infections including urethritis, cervicitis, vaginitis and genital ulceration, and may also infect the rectum and pharynx. Other STIs may cause serious short-term and long-term complications (e.g. pelvic inflammatory disease, arthritis, encephalitis), increase the risk of ectopic pregnancy and tubal-related infertility, and are associated with stillbirth and other adverse pregnancy outcomes.2 Furthermore, susceptibility to acquiring HIV as well as HIV infectiousness may be increased depending on which STI is involved.3 Lastly, the emergence of antibiotic-resistant gonorrhoea and consequent limited therapeutic options has become a major public health concern, impacting STI management and control activities.4 The World Health Organization’s (WHO) Global Health Sector strategy 2022–2030 details the vision, goals and actions to ending the STI epidemic.5 Strengthening STI case management is one of the key priorities of this strategy. Effective people-centred STI case management is context-dependent and determined by available resources.6 In settings with limited resources, despite its shortcomings, syndromic case management using flow charts is the standard of care. Male urethral discharge syndrome (MUDS), vaginal discharge syndrome (VDS) and genital ulcer disease (GUD) are the main STI-associated conditions in this approach, and each of these syndromes has a diverse microbial aetiology (Table 1).6,7,8,9,10,11,12,13,14 Where resources are available, diagnostic tests for specific pathogens, combined with directed treatment, can be used to optimise STI screening and case management.