| Screening for sexually transmitted infections (STIs) among men who have sex with men (MSM) is not routinely available in South Africa’s public sector. Current STI management guidelines also lack algorithms for screening or treating extragenital infections. This remains the case despite MSM, estimated to constitute at least 1% (218,000) of the adult male population, and transgender women (TGW) being considered key populations for acquiring HIV and STIs due to biological factors, engagement in high-risk sexual practices, and structural barriers to accessing healthcare services.A recent national survey found that 86% of MSM use the public healthcare system, which manages STIs syndromically, focussing solely on urogenital symptoms. However, among MSM, the anatomical sites of infection often include the oro-pharynx and rectum—collectively referred to as extragenital sites—where infections are largely asymptomatic. The latest report from the Public Health Bulletin South Africa (PHBSA) assesses the burden of asymptomatic extragenital STIs and examines the aetiologies of symptomatic male urethritis, while monitoring N. gonorrhoeae resistance in culture-positive isolates and detecting other emerging STI pathogens in high-risk MSM from Johannesburg. For full access to the report, click here. For more information about PHBSA, visit https://www.phbsa.ac.za/. |
 Dr Bianca Da Costa Dias, a lead investigator for the study “Sexually transmitted infections surveillance among a high-risk men who have sex with men (MSM) cohort in Johannesburg, South Africa, 2023,” explains how the study came about and her role in it.What is this study about?This study investigated the occurrence of sexually transmitted infections (STIs) among men who have sex with men (MSM). This study is unique in that we looked for these infections in the throat and anus in addition to the genitals in both men with and without penile discharge (the typical symptom associated with these STI pathogens in males).Why does this matter? Men who have sex with men, despite being at increased risk of STIs, often go undiagnosed due to a lack of symptoms. This study reveals that approximately 2 in 5 MSM have an STI, even when they show no symptoms. These unnoticed and untreated infections can lead to transmission to uninfected partners. Furthermore, our study highlights the high rates of syphilis in this group. What drew your interest in this area of research? Non-HIV STIs are largely overlooked in MSM studies in South Africa. Globally, the prevalence of and antimicrobial resistance in STI pathogens is increasing, which often disproportionately affects MSM. Historically, MSM have been unrepresented in national STI surveillance programmes. Yet, they represent people who bear a significant burden of disease. Thus, we actively sought to address this by establishing the first sentinel site in which MSM are exclusively recruited, and we hope to expand our efforts in the future. What was your role in the study? As the lead researcher (principal investigator) on this study, I played a pivotal role in overseeing the entire project, ensuring the scientific and ethical integrity of the study, and reporting our findings to various national and international stakeholders. Additionally, I was involved in the molecular testing for this study, working closely with other scientists in the unit. Why should people read this article? Policymakers, clinicians, researchers, and MSM themselves should read this article to improve their knowledge of STIs, increase awareness about asymptomatic STIs within their communities, and ultimately generate demand for STI testing services in MSM. What impact do you hope this study will have on public health policy and access to healthcare? The findings of this study are crucial for public health policy and access to healthcare. We hope this study will underscore the necessity of testing for syphilis and other STIs in the genitals, throat, and anus, regardless of symptoms in MSM. We aim to use our findings to advocate for the implementation of these services in the public healthcare sector. Dr Bianca Da Costa Dias is a senior medical scientist in the Centre for HIV & STIs, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa. |
Sexually transmitted infections surveillance among high-risk men who have sex with men (MSM) cohort in Johannesburg, South Africa, 2023
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