The control and prevention of sexually transmitted infections in primary healthcare facilities among key and priority population in sub-Saharan Africa: A systematic review

Mohlago A. Seloka, Edith Phalane, Refilwe N. Phaswana-Mafuya

Abstract

The syndromic management approach lacks diagnostic accuracy for asymptomatic infections, although it is the standard STI treatment method. The study aimed to understand the status quo on sexually transmitted infections (STI) control in primary healthcare (PHC) facilities among key and priority populations in sub-Saharan Africa (SSA). We registered the review on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (ID: CRD42023439416). A systematic search of published articles was done using online databases and grey literature between 2016 and 2024. The search identified 2283 studies, and 1251 were excluded, remaining with 39 eligible studies for inclusion across 15 SSA countries. Of the 39 eligible studies, 11 were conducted on laboratory-diagnostic methods, and 28 were on treatment for STIs. Laboratory-diagnostic methods, including Gene Xpert assay, nucleic acid amplification transcriptase test, and multiplex reverse transcription polymerase chain reaction, have high diagnostic accuracy, sensitivity and specificity rates. However, they may result in delayed sampled results. Eighteen studies indicate that the STI syndromic management approach remains the standard care for treatment in PHC facilities, but its challenges include drug resistance, misdiagnosis, and low sensitivity. Integrating syndromic management with laboratory-diagnostic methods can improve diagnostic accuracy and allow early identification, diagnosis and treatment of STIs. These findings aim to inform policymakers and STI stakeholders to provide scientific evidence for targeted approaches to optimise and strengthen the STI response in SSA

Full Text:

PDF

References

World Health Organization. Guidelines for the

management of symptomatic sexually transmitted

infections., 2021. Accessed July 2021.

https://www.who.int/publications/i/item/9789240024168.

World Health Organization Global health sector strategies

on, respectively, HIV, viral hepatitis and sexually

transmitted infections for the period 2022-2030.

Accessed June 2022.

https://www.who.int/publications/m/item/global

health-sector-strategies-on-respectively-hiv-viral

hepatitis-and-stis-for-2022-2030.

World Health Organization. The diagnostics landscape for

sexually transmitted infections. 2023.

https://www.who.int/publications-detail

redirect/9789240077126. Accessed August 2023.

Wynn A, Moucheraud C, Martin NK, Morroni C,

Ramogola-Masire D, Klausner JD, and Leibowitz A.

Bridging the gap between pilot and scale-up: a model

of antenatal testing for curable sexually transmitted

infections from Botswana. Sexually Transmitted

Diseases. 2022 Jan 1;49(1):59-66.

Martin K, Dziva Chikwari C, Mackworth-Young CR,

Chisenga M, Bandason T, Dauya E, Olaru ID,

Francis SC, Mavodza C, Nzombe P, and Nyamwanza

R. “It was difficult to offer same day results”:

evaluation of community-based point-of-care testing

for sexually transmitted infections among youth

using the GeneXpert platform in Zimbabwe. BMC

health services research. 2022 Feb 10;22(1):171.

Kularatne R, Maseko V, Mahlangu P, Muller E, and Kufa

T. Etiological surveillance of male urethritis

syndrome in South Africa: 2019 to 2020. Sexually

Transmitted Diseases. 2022 Aug 1;49(8):560-4.

Adawaye C, Souleymane AO, Fouda AA, Djarma O,

Cournil A, Tuaillon E, and Mennechet FJ. Syphilis

diagnosis and serological response to Benzathine

Penicillin G among patients attending HIV clinics in

N’Djaména, Chad. International Journal of

Infectious Diseases. 2021 Jul 1;108:461-4.

Karim S, Bouchikhi C, Banani A, El Fatemi H, Souho T,

Erraghay S, and Bennani B. Bacterial sexually

transmitted infections and syndromic approach: a

study conducted on women at Moroccan University

Hospital. Germs. 2021 Dec;11(4):544.

Katanga J, Kjaer SK, Manongi R, Pembe AB, Iftner T,

Waldstrom M, Mwaiselage J, and Rasch V.

Agreement between care HPV and hybrid capture 2

in detecting high‐risk HPV in women in Tanzania.

Acta Obstetricia et Gynecologica Scandinavica.

Apr;100(4):786-93.

Maina AN, Mureithi MW, Ndemi JK, and Revathi G.

Diagnostic accuracy of the syndromic management

of four STIs among individuals seeking treatment at

a health centre in Nairobi, Kenya: a cross-sectional

study. Pan African Medical Journal. 2021 Nov

;40(1).

Mathews C, Lombard C, Kalichman M, Dewing S, Banas

E, Dumile S, Mdlikiva A, Mdlikiva T, and Jennings

KA, Daniels J, Berteler M. Effects of enhanced STI

partner notification counselling and provider

assisted partner services on partner referral and the

incidence of STI diagnosis in Cape Town, South

Africa: randomised controlled trial. Sexually

Transmitted Infections. 2021 Feb 1;97(1):38-44.

Peters RP, Klausner JD, De Vos L, Feucht UD, and

Medina‐Marino A. Aetiological testing compared

with syndromic management for sexually transmitted

infections in HIV‐infected pregnant women in South

Africa: a non‐randomised prospective cohort study.

BJOG: An International Journal of Obstetrics and

Gynaecology. 2021 Jul;128(8):1335-42.

Wall KM, Nyombayire J, Parker R, Ingabire R, Bizimana

J, Mukamuyango J, Mazzei A, Price MA,

Unyuzimana MA, Tichacek A, and Allen S.

Etiologies of genital inflammation and ulceration in

symptomatic Rwandan men and women responding

to radio promotions of free screening and treatment

services. Plos One. 2021 Apr 20;16(4):e0250044.

Chitneni P, Beksinska M, Dietrich JJ, Jaggernath M,

Closson K, Smith P, Lewis DA, Matthews LT, Smit

J, Ndung’u T, and Brockman M. Partner notification

and treatment outcomes among South African

adolescents and young adults diagnosed with a

sexually transmitted infection via laboratory-based

screening. International Journal of STD and AIDS.

Jun;31(7):627-36.

Medina-Marino A, Glockner K, Grew E, De Vos L,

Olivier D, Klausner J, and Daniels J. The role of trust

and health literacy in nurse-delivered point-of-care

STI testing for pregnant women living with HIV,

Tshwane District, South Africa. BMC Public Health.

Dec;20:1-9.

Thivalapill N, Jasumback CL, Perry SH, Dlamini L,

Matsenjwa M, Masangane ZT, Mavimbela M,

Mthethwa N, Kirchner HL, Mphaya J, and Lukhele

B. Predicting Sexually Transmitted Infections

Among HIV+ Adolescents and Young Adults: A

Novel Risk Score to Augment Syndromic

Management in Eswatini. JAIDS Journal of

Acquired Immune Deficiency Syndromes. 2020 Dec

;85(5):543-52.

Morikawa E, Mudau M, Olivier D, De Vos L, Joseph

Davey D, Price C, McIntyre JA, Peters RP, Klausner

JD, and Medina-Marino A. Acceptability and

feasibility of integrating point‐of‐care diagnostic

testing of sexually transmitted infections into a South

African antenatal care program for HIV‐infected

pregnant women. Infectious Diseases In Obstetrics

And Gynecology. 2018;2018(1):3946862.

Huchko MJ, Ibrahim S, Blat C, Cohen CR, Smith JS, Hiatt

RA, and Bukusi E. Cervical cancer screening through

human papillomavirus testing in community health

campaigns versus health facilities in rural western

Kenya. International Journal of Gynecology and

Obstetrics. 2018 Apr;141(1):63-9.

Kaida A, Dietrich JJ, Laher F, Beksinska M, Jaggernath

M, Bardsley M, Smith P, Cotton L, Chitneni P,

Closson K, and Lewis DA. A high burden of

asymptomatic genital tract infections undermines the

syndromic management approach among

adolescents and young adults in South Africa:

implications for HIV prevention efforts. BMC

Infectious Diseases. 2018 Dec;18:1-1.

Mbulawa ZZ, Van Schalkwyk C, Hu NC, Meiring TL,

Barnabas S, Dabee S, Jaspan H, Kriek JM, Jaumdally

SZ, Muller E, and Bekker LG. High human

papillomavirus (HPV) prevalence in South African

adolescents and young women encourages expanded

HPV vaccination campaigns. PloS one. 2018 Jan

;13(1):e0190166.

Kilmarx PH, Gonese E, Lewis DA, Chirenje ZM, Barr

BA, Latif AS, Gwanzura L, Handsfield HH, Machiha

A, Mugurungi O, and Rietmeijer CA. HIV infection

in patients with sexually transmitted infections inZimbabwe–Results from the Zimbabwe STI etiology

study. PloS one. 2018 Jun 11;13(6):e0198683.

Olugbenga I, Taiwo O, Laverty M, Ngige E, Anyaike C,

Bakare R, Ogunleye V, Peterson Maddox BL,

Newman DR, Gliddon HD, and Ofondu E. Clinic

based evaluation study of the diagnostic accuracy of

a dual rapid test for the screening of HIV and syphilis

in pregnant women in Nigeria. Plos One. 2018 Jul

;13(7):e0198698.

South Africa, National Department of Health, Sexually

Transmitted Infections Management Guidelines,

Adapted from Standard Treatment Guidelines

and Essential Medicine List PHC. 2018. Accessed.

sti-guidelines-27-08-19.pdf (health.gov.za).

Kenya National Guidelines for Prevention, Management

and Control of Sexually Transmitted Infections,

Ministry of Health, 2018. Accessed October 2018.

https://www.dknowledge.co.ke/sass/notes/final%20

STI%20guidelines%2017th%20October%20%2020

pdf

Masese LN, Wanje G, Kabare E, Budambula V, Mutuku

F, Omoni G, Baghazal A, Richardson BA, and

McClelland RS. Screening for sexually transmitted

infections in adolescent girls and young women in

Mombasa, Kenya: feasibility, prevalence, and

correlates. Sexually Transmitted Diseases. 2017 Dec

;44(12):725-31.

Malawi, Ministry of Health. Malawi Guidelines for

Syndromic Management of Sexually Transmitted

Infections 2017.

https://www.malawiempower.org/wp

content/uploads/2021/09/Malawi-Guidelines-for

Syndromic-Management-of-Sexually-Transmitted

Infections-2017-A5-SIZE-1.pdf.

National Guidelines for Prevention and Management of

HIV and STIs, Republic of Rwanda, Ministry of

Health, Edition, 2016. Accessed. November 2016.

SIGNED ENGLISH (rbc.gov.rw). 2016 VERSION.pdf

Katusiime C, Schlech III WF, Parkes-Ratanshi R, Sempa

J, and Kambugu A. Characteristics of sexually

transmitted infections among high-risk HIV-positive

patients attending an urban clinic in Uganda. Journal

of the International Association of Providers of AIDS

Care. 2016 Jan;15(1):36-41.

Mayanja Y, Mukose AD, Nakubulwa S, Omosa

Manyonyi G, Kamali A, and Guwatudde D.

Acceptance of treatment of sexually transmitted

infections for stable sexual partners by female sex

workers in Kampala, Uganda. PLoS One. 2016 May

;11(5):e0155383.

Sylverken AA, Owusu-Dabo E, Yar DD, Salifu SP,

Awua-Boateng NY, Amuasi JH, Okyere PB, and

Agyarko-Poku T. Bacterial etiology of sexually

transmitted infections at an STI clinic in Ghana; use

of multiplex real time PCR. Ghana Medical Journal.

Sep 29;50(3):142-8.

Ali S, Sewunet T, Sahlemariam Z, and Kibru G. Neisseria

gonorrhoeae among suspects of sexually transmitted

infection in Gambella hospital, Ethiopia: risk factors

and drug resistance. BMC Research Notes. 2016

Dec;9:1-8.

Adamson PC, Loeffelholz MJ, and Klausner JD. Point-of

Care Testing for Sexually Transmitted Infections: A

Review of Recent Developments. Arch Pathol Lab

Med. 2020 Nov 1;144(11):1344-1351. doi:

5858/arpa.2020-0118-RA. PMID: 32810868;

PMCID: PMC7606737.

Hsieh K, Melendez JH, and Gaydos CA, Wang TH.

Bridging the gap between development of point-of

care nucleic acid testing and patient care for sexually

transmitted infections. 2022;22(3):476-511. Lab on a Chip.

Martin K, Wenlock R, Roper T, Butler C, and Vera JH.

Facilitators and barriers to point-of-care testing for

sexually transmitted infections in low-and middle

income countries: a scoping review. BMC Infectious

Diseases. 2022 Jun 20;22(1):561.

Xie TA, Liu YL, Meng RC, Liu XS, Fang KY, Deng ST,

Fan SJ, Chen CM, Lin QR, He ZJ, and Li ZX.

Evaluation of the diagnostic efficacy of Xpert

CT/NG for Chlamydia trachomatis and Neisseria

gonorrhoeae. BioMed Research International.

;2020(1):2892734.

Van Der Pol B, Williams JA, Fuller D, Taylor SN, and

Hook III EW. Combined testing for chlamydia,

gonorrhea, and trichomonas by use of the BD Max

CT/GC/TV assay with genitourinary specimen types.

Journal of clinical Jan;55(1):155-64. microbiology. 2017

Caruso G, Giammanco A, Virruso R, and Fasciana T.

Current and future trends in the laboratory diagnosis

of sexually transmitted infections. International

Journal of Environmental Research and Public

Health. 2021 Feb;18(3):1038.

Luetkemeyer AF, Donnell D, Dombrowski JC, Cohen S,

Grabow C, Brown CE, Malinski C, Perkins R, Nasser

M, Lopez C, and Vittinghoff E. Postexposure

doxycycline to prevent bacterial sexually transmitted

infections. New England Journal of Medicine. 2023

Apr 6;388(14):1296-306.

Wood JM, Harries J, Kalichman M, Kalichman S, Nkoko

K, and Mathews C. Exploring motivation to notify

and barriers to partner notification of sexually

transmitted infections in South Africa: a qualitative

study. BMC Public Health. 2018 Dec;18:1-7.

Taleghani S, Joseph-Davey D, West SB, Klausner HJ,

Wynn A, and Klausner JD. Acceptability and

efficacy of partner notification for curable sexually

transmitted infections in sub-Saharan Africa: A

systematic review. International Journal of STD &

AIDS. 2019 Mar;30(3):292-303.

National Institute for Health and Care Excellence, 2022.

Partner notification methods to prevent or reduce

STIs. London: NICE; 2022 Jun.

https://www.ncbi.nlm.nih.gov/books/NBK589853/#

:~:text=If%20people%20are%20aware%20of,clinic

%20to%20get%20tested%20themselves.

Hogben M, Collins D, Hoots B, and O'Connor K. Partner

services in sexually transmitted disease prevention

World Health Organization, Human papillomavirus and

cancer., 2024. Accessed

March https://www.who.int/news-room/fact2024,

sheets/detail/human-papilloma-virus-and-cancer

Mukwevho N. National Strategic Plan., 2023-2028:

Addressing barriers to accessing health and social

services. Journalism for public health. 2023.

https://bhekisisa.org/wp

content/uploads/2023/03/NSP-HIV-TB-STIs-2023

-MARCH20_23-PRINT2.pdf. Accessed May

Taylor M, Alonso-González M, Gómez B, Korenromp E,

and Broutet N. World Health Organization global

health sector strategy on sexually transmitted

infections: an evidence-to-action summary for

Colombia. Revista colombiana de obstetricia y

ginecologia. 2017 Sep;68(3):193-201.

World Health Organisation. Accelerating the global

Sexually Transmitted Infections response: report on

the first informal Think-Tank meeting. Geneva:2021.

https://iris.who.int/bitstream/handle/10665/341678/

-eng.pdf?sequence=1.

Human Science Research Council, Sixth South African

National HIV Prevalence, Incidence, and Behaviour

(SABSSM VI) survey. Three HSRC flagship projects

celebrate 20 years. Accessed December 2023.

https://hsrc.ac.za/wp

content/uploads/2023/12/HSRC-Review-December

pdf.

Ayerdi Aguirrebengoa O, Vera García M, Arias Ramírez

D, Gil García N, Puerta López T, Clavo Escribano P,

Ballesteros Martín J, Lejarraga Cañas C, Fernandez

Piñeiro N, Fuentes Ferrer ME, and García Lotero M.

Low use of condom and high STI incidence among

men who have sex with men in PrEP programs. Plos

One. 2021 Feb 4;16(2):e0245925.

Workowski KA, and Bachmann LH. Centers for disease

control and prevention’s sexually transmitted

diseases infection guidelines. Clinical Infectious

Diseases. 2022 Apr 15;74(Supplement_2):S89-94.

Garrett NJ, Osman F, Maharaj B, Naicker N, Gibbs A,

Norman E, Samsunder N, Ngobese H, Mitchev N,

and Singh R, and Abdool Karim SS. Beyond

syndromic management: opportunities for diagnosis

based treatment of sexually transmitted infections in

low-and middle-income countries. Plos One. 2018

Apr 24;13(4):e0196209.

Carveth-Johnson T, De Skrzynno SD, Wynn A,

Moshashane N, Ramontshonyana K, Lebelonyane R,

Mussa A, Ramogola-Masire D, Klausner J, and

Morroni C. Integrating Sexually Transmitted

Infection Testing and Treatment With Routine HIV

Care in Gaborone, Botswana. Sexually Transmitted

Diseases. 2021 Nov 1;48(11):887-94.

Nyemba DC, Peters RP, Medina-Marino A, Klausner JD,

Ngwepe P, Myer L, Johnson LF, and Joseph Davey

DL. Impact of aetiological screening of sexually

transmitted infections during pregnancy-on

pregnancy outcomes in South Africa. BMC

Pregnancy And Childbirth. 2022 Mar 9;22(1):194.

Nakku-Joloba E, Kiguli J, Kayemba CN, Twimukye A,

Mbazira JK, Parkes-Ratanshi R, Birungi M, Kyenkya

J, Byamugisha J, Gaydos C, and Manabe YC.

Perspectives on male partner notification and

treatment for syphilis among antenatal women and

their partners in Kampala and Wakiso districts,

Uganda. BMC Infectious Diseases. 2019 Dec;19:

-3. 15. Mokgatle M, Madiba S, and Hlongwane N. Differences in

sexual behaviour and partner notification for

sexually transmitted infections between the out-of

school youth and university students in a peri-urban

district in South Africa—A cross-sectional survey.

Frontiers in Public Health. 2022 Jun 22;10:793702.

Stewart J, Bukusi E, Sesay FA, Oware K, Donnell D, Soge

OO, Celum C, Odoyo J, Kwena ZA, Scoville CW,

and Violette LR. Doxycycline post-exposure

prophylaxis for prevention of sexually transmitted

infections among Kenyan women using HIV pre

exposure prophylaxis: study protocol for an open

label randomised trial. Trials. 2022 Jun 16;23(1):495.

Amir-Behghadami M, and Janati A. Population,

Intervention, Comparison, Outcomes and Study

(PICOS) design as a framework to formulate

eligibility criteria in systematic reviews. Vol. 37,

Emergency Medicine Journal. England; 2020. p. 387.

Critical Appraisal Skills Programme. (2021). CASP

systematic reviews appraisal tool. 2020. Accessed

August 2020. https://casp-uk.net/casp-tools

checklists/systematic-reviews-meta-analysis-rcts/.

Equator Network. The PRISMA. Statement: The updated

guideline for s reporting systematic reviews. 2020:

Accessed April 2024. https://www.equator

network.org/reporting- guidelines/prisma/.

Manjate A, Sergon G, Kenga D, Golparian D, Tyulenev

Y, Loquilha O, Mausse F, Guschin A, Langa JC,

Passanduca A, and Sacarlal J. Prevalence of sexually

transmitted infections (STIs), associations with

sociodemographic and behavioural factors, and

assessment of the syndromic management of vaginal

discharge in women with urogenital complaints in

Mozambique. Frontiers in Reproductive Health.

Apr 18;6:1323926.

Mwenda V, Bor JP, Nyangasi M, Njeru J, Olwande S,

Njiri P, Arbyn M, Weyers S, Tummers P, and

Temmerman M. Integrating human papillomavirus

testing as a point-of care service using GeneXpert

platforms: Findings and lessons from a Kenyan pilot

study (2019–2020). Plos One. 2023 May

;18(5):e0286202.

Chikwari CD, Simms V, Kranzer K, Dauya E, Bandason

T, Tembo M, Mavodza C, Machiha A, Mugurungi O,

Musiyandaka P, and Mwaturura T. Evaluation of a

community-based aetiological approach for sexually

transmitted infections management for youth in

Zimbabwe: intervention findings from the STICH

cluster randomised trial. EClinicalMedicine. 2023

Aug 1;62.

Smith E, Masson L, Passmore JA, and Sinanovic E. Cost

effectiveness analysis of different screening and

diagnostic strategies for sexually transmitted

infections and bacterial vaginosis in women

attending primary health care facilities in Cape

Town. Frontiers in Public Health. 2023 Mar

;11:1048091.

Makura C. Landscape analysis report on Sexually

Transmitted Infections Prevention, Treatment and

Management Strategies in Zimbabwe. 2023.

Accessed November 2023. PZAT_STI-Landscape

analysis-presentation_.pdf (avac.org).

programs: A review. Sexually Transmitted Diseases.

Feb 1;43(2S):S53-62.

Gupta V, and Sharma VK. Syndromic management of

sexually transmitted infections: A critical appraisal

and the road ahead. National Medical Journal of

India. 2019 May 1;32(3).

PATH Global HPV Vaccine Introduction Overview.

Available online at:

https://www.path.org/resources/global-hpv-vaccine

introduction-overview/ (accessed August 31, 2021).

pdf/condom_programme_strategy_summaryia

Kadiri KK, Ahmad MK and Mustaffa CS. Cultural

sensitivity in sexually transmitted infections (stis)

preventive campaign in nigeria. Procedia - Social and

Behavioral Sciences, 2014: 155, 331-336.

Crooks N, Wise A and Frazier T. Addressing sexually

transmitted infections in the sociocultural context of

black heterosexual relationships in the United States.

Social Science & Medicine. 2020 Oct 1;263:113303.

Maddock M. Is There a Relationship Between Religiosity

and Infidelity? A Meta-Analysis (Doctoral

dissertation, Brigham Young University).

World Health Organization. Traditional Medicine. 2023.

https://www.who.int/news-room/questions-and

answers/item/traditional-medicine. Accessed August

Chinsembu KC. Ethnobotanical study of medicinal flora

utilised by traditional healers in the management of

sexually transmitted infections in Sesheke District,

Western Province, Zambia. Revista Brasileira de

Farmacognosia. 2016 Mar;26:268-74.

Nazer M, Abbaszadeh S, Darvishi M, Kheirollahi A,

Shahsavari S and Mopghadasi M. The most

important herbs used in the treatment of sexually

transmitted infections in traditional medicine. Sudan

Journal of Medical Sciences. 2019 Jul 22;14(2):

-64.

Refbacks

  • There are currently no refbacks.