Sexually transmitted diseases (STDs) are a major health issue in southern Africa. It has been estimated that over 1 million people seek treatment for STDs every year in private practices and municipal clinics. And many more than this seek help at hospitals and primary health care clinics. It is, however, believed that most STD cases in Africa are not presented at Western health facilities, but that they are treated by traditional healers (Green 1994).
For the following reasons, patients who have sexually transmitted diseases are particularly prone to HIV infection:
- Patients with genital ulcers (sores) are especially susceptible to HIV infection because the sores create openings in the mucuous membranes – openings through which the HI virus can easily move.
- Statistical evidence suggests that STD infections, which do not cause ulcers, can also facilitate the transmission of HIV (Green 1994). Genital inflammation causes the migration of millions of lymphocytes (such as CD4 cells) to the site of the infection (in and around the genital tract). As we noted earlier, these cells have special receptors on their surfaces, receptors to which HI viruses attach themselves in preparation for easy entry into the body. (Evian, 2000). STDs (especially genital ulcers) thus make it five to ten times easier for the HI virus to enter the body.
- The concentration (number) of HI viruses is very high in genital discharges and secretions. An HIV-infected person who also suffers from an STD is obviously therefore extremely infectious.
- People with STDs are also more vulnerable to HIV because the likelihood is much greater that they are having sex with many different partners.. This increases their risk of coming into contact with sexually transmitted infections and HIV.
- Because an HIV infection may delay the healing and cure of STDs, HIV infection often makes STDs more acute and difficult to treat.
Special attention should therefore be paid to patients who frequently visit STD clinics, and health care professionals should always be on the lookout for HIV infection. Most non-viral STDs are curable and preventable. It is therefore of the utmost importance for health care professionals to identify people with STDs as soon as possible, to treat them and to refer them for HIV testing after pre-test counselling.
It is the belief of many Aids researchers in Africa that the control of STDs may be the key to combating HIV. In South African mines, for example, health care professionals attempt to combat Aids by preventing and treating STDs.
It is extremely important to recognise the main symptoms of all STDs.
The most important STDs associated with HIV infection can be divided into five categories. These categories are distinguished in terms of the main symptoms that each STD causes:
- Discharge from the penis or the female uretra or cervix – associated with gonorrhoea and chlamydia. Also candidiasis.
- Discharge from the vagina – associated with trichomoniasis and bacterial vaginosis. Also genital candidiasis (thrush).
- Genital ulcer/sores – associated with syphilis, genital herpes and chancroid.
- Genital discharge as well as genital ulcer or sore – associated with almost all STDs.
- Lower abdominal pain – associated with Acute Pelvic Inflammatory Disease.