Partner notification and treatment outcomes among South African adolescents and young adults diagnosed with a sexually transmitted infection via laboratory-based screening
Restricted accessResearch articleFirst published online June, 2020
Partner notification and treatment outcomes among South African adolescents and young adults diagnosed with a sexually transmitted infection via laboratory-based screening
Partner notification and treatment are essential components of sexually transmitted infection (STI) management, but little is known about such practices among adolescents and young adults. Using data from a prospective cohort study (AYAZAZI) of youth aged 16–24 years in Durban, South Africa, we assessed the STI care cascade across participant diagnosis, STI treatment, partner notification, and partner treatment; index recurrent STI and associated factors; and reasons for not notifying partner of STI. Participants completed laboratory-based STI screening (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis) at enrollment and at 12 months. Of the 37/216 participants with STI (17%), 27/37 (73%) were women and 10/37 (27%) were men. Median age was 19 years (IQR: 18–20). Of the participants with STI, 23/37 (62%) completed a Treatment and Partner Tracing Survey within 6 months of diagnosis. All survey participants reported completing STI treatment (100%), 17/23 (74%) notified a partner, and 6/23 (35%) reported partner treatment. Overall, 4/23 (11%) participants had 12-month recurrent C. trachomatis infection, with no association with partner notification or treatment. Stigma and lack of STI knowledge were reasons for not notifying partner of STI. STI partner notification and treatment is a challenge among youth. Novel strategies are needed to overcome barriers along the STI care cascade.
RowleyJVander HoornSKorenrompE, et al.
Chlamydia, gonorrhoea, trichomoniasis and syphilis: Global prevalence and incidence estimates, 2016. Bull World Health Organ2019;
97: 548–562P.
2.
WardHRonnM.Contribution of sexually transmitted infections to the sexual transmission of HIV. Curr Opin HIV AIDS2010;
5: 305–310.
3.
LagaMManokaAKivuvuM, et al.
Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: Results from a cohort study. AIDS1993;
7: 95–102.
4.
KorenrompELRowleyJAlonsoM, et al.
Correction: Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012. PLoS One2019;
14: e0219613.
5.
KorenrompELRowleyJAlonsoM, et al.
Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012. PLoS One2019;
14: e0211720.
6.
TorroneEAMorrisonCSChenPL, et al.
Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies. PLoS Med2018;
15: e1002511.
7.
TorroneEAMorrisonCSChenPL, et al.
Correction: Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies. PLoS Med2018;
15: e1002608.
8.
DehneKLGabrieleR. Sexually transmitted infections among adolescents: The need for adequate health services. Geneva: World Health Organization, 2005.
9.
BearingerLHSievingREFergusonJ, et al.
Global perspectives on the sexual and reproductive health of adolescents: Patterns, prevention, and potential. Lancet2007;
369: 1220–1231.
10.
UNAIDS. Prevention Gap Report, Geneva: UNAIDS, 2016.
11.
KaidaADietrichJJLaherF, et al.
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 Infect Dis2018;
18: 499.
12.
ZgamboMKalemboFWMbakayaBC.Risky behaviours and their correlates among adolescents living with HIV in sub-Saharan Africa: A systematic review. Reprod Health2018;
15: 180.
13.
TyleeAHallerDMGrahamT, et al.
Youth-friendly primary-care services: How are we doing and what more needs to be done?Lancet2007;
369: 1565–1573.
14.
KatzKNareC.Reproductive health knowledge and use of services among young adults in Dakar, Senegal. J Biosoc Sci2002;
34: 215–231.
15.
ElsterABMarcellAV.Health care of adolescent males: Overview, rationale, and recommendations. Adolesc Med2003;
14: 525–540.
17. WHO/UNAIDS.Guidelines for the management of sexually transmitted infections.
Geneva:
World Health Organization, 2004.
18.
WHO/UNAIDS. Sexually transmitted diseases: Policies and principles for prevention and care, Geneva: World Health Organization, 1999.
19.
FerreiraAYoungTMathewsC, et al.
Strategies for partner notification for sexually transmitted infections, including HIV. Cochrane Database Syst Rev2013; CD002843.
20.
World Health Organization. Global health sector strategy on sexually transmitted infections 2016-2021.
Geneva:
World Health Organization, 2016.
21.
WoodJMHarriesJKalichmanM, et al.
Exploring motivation to notify and barriers to partner notification of sexually transmitted infections in South Africa: A qualitative study. BMC Public Health2018;
18: 980.
22.
TSAAC. Let our actions count: South Africa’s national strategic plan for HIV, TB, and STIs 2017–2022, Pretoria: South African National AIDS Council, 2017.
23.
MathewsCKalichmanMOLaubscherR, et al.
Sexual relationships, intimate partner violence and STI partner notification in Cape Town, South Africa: An observational study. Sex Transm Infect2018;
94: 144–150.
24.
NuwahaF.Factors influencing timing of seeking health care among patients with sexually transmitted diseases in Kampala, Uganda. Cent Afr J Med1999;
45: 320–323.
25.
SteenRSolimanCBucyanaS, et al.
Partner referral as a component of integrated sexually transmitted disease services in two Rwandan towns. Genitourin Med1996;
72: 56–59.
26.
GichangiPFonckKSekande-KigonduC, et al.
Partner notification of pregnant women infected with syphilis in Nairobi, Kenya. Int J STD AIDS2000;
11: 257–261.
27.
BarnabasSLDabeeSPassmoreJ-A, et al.
Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV. Int J STD AIDS2018;
29(6): 531–539.
28.
FrancisSCMthiyaneTNBaisleyK, et al.
Prevalence of sexually transmitted infections among young people in South Africa: A nested survey in a health and demographic surveillance site. PLoS Med2018;
15: e1002512.
29.
LewisDAPillayCMohlamonyaneO, et al.
The burden of asymptomatic sexually transmitted infections among men in Carletonville, South Africa: Implications for syndromic management. Sex Transm Infect2008;
84: 371–376.
30.
WhiteRGMoodleyPMcGrathN, et al.
Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa. Sex Transm Infect2008;
84: 528–534.
31.
MlisanaKNaickerNWernerL, et al.
Symptomatic vaginal discharge is a poor predictor of sexually transmitted infections and genital tract inflammation in high-risk women in South Africa. J Infect Dis2012;
206: 6–14.
32.
CristilloADBristowCCPeelingR, et al.
Point-of-Care Sexually Transmitted Infection Diagnostics: Proceedings of the STAR Sexually Transmitted Infection-Clinical Trial Group Programmatic Meeting. Sex Transm Dis2017;
44: 211–218.
33.
Dietrich PsJHornschuhSMathenjwaT, et al. “At AYAZAZI, they do something.” Factors motivating participation in a youth-centred cohort study on HIV prevention in Soweto and Durban, South Africa. In: 2017 South African AIDS Conference 2017, Durban, South Africa, 13–16 June 2017.
34.
TsadikMBerhaneYWorkuA, et al.
Perceived risk of reinfection among individuals treated for sexually transmitted infections in Northern Ethiopia: Implication for use in clinical practice. Pan Afr Med J2017;
27: 87.
35.
KalichmanSCMathewsCKalichmanM, et al.
Perceived barriers to partner notification among sexually transmitted infection clinic patients, Cape Town, South Africa. J Public Health2017;
39: 407–414.
36.
FaxelidETemboGNduloJ, et al.
Individual counseling of patients with sexually transmitted diseases. A way to improve partner notification in a Zambian setting?Sex Transm Dis1996;
23: 289–292.
37.
MercerCHAickenCRTantonC, et al.
Serial monogamy and biologic concurrency: Measurement of the gaps between sexual partners to inform targeted strategies. Am J Epidemiol2013;
178: 249–259.
38.
WynnAMoucheraudCMoshashaneN, et al.
Using partner notification to address curable sexually transmitted infections in a high HIV prevalence context: A qualitative study about partner notification in Botswana. BMC Public Health2019;
19: 606.
39.
ShovellerJKnightRDavisW, et al.
Online sexual health services: Examining youth’s perspectives. Can J Public Health2012;
103: 14–18.
40.
PellowskiJMathewsCKalichmanMO, et al.
Advancing partner notification through electronic communication technology: A review of acceptability and utilization research. J Health Commun2016;
21: 629–637.
41.
NuwahaFKambuguFNsubugaPS, et al.
Efficacy of patient-delivered partner medication in the treatment of sexual partners in Uganda. Sex Transm Dis2001;
28: 105–110.
42.
KenyonCBuyzeJKlebanoffM, et al.
The role of sexual networks in studies of how BV and STIs increase the risk of subsequent reinfection. Epidemiol Infect2018;
146: 2003–2009.
43.
RottingenJACameronDWGarnettGP.A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: How much really is known?Sex Transm Dis2001;
28: 579–597.
44.
RoseSBGarrettSMKennedyJ, et al.
Partner notification and retesting for Chlamydia trachomatis and Neisseria gonorrhoeae: A case-note review in New Zealand primary care. J Prim Health Care2018;
10: 132–139.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
