The Silent Epidemic: Understanding STIs in South Africa and the Role of USAID

Cornelia Postma
Feb 26
4 min read

26 February 2025

Sexually transmitted infections (STIs) remain one of South Africa’s most pressing yet overlooked public health challenges. While significant strides have been made in tackling HIV, the high prevalence of STIs such as gonorrhoea, chlamydia, and syphilis continues to place millions at risk. The consequences of these infections extend far beyond individual health, affecting fertility, increasing vulnerability to HIV, and placing additional strain on an already burdened healthcare system. While global organisations such as USAID (United States Agency for International Development) have played a role in addressing these concerns, there is still much work to be done to turn the tide on this silent epidemic.

The STI Crisis in South Africa

South Africa has one of the highest STI burdens in the world, with staggering numbers of new infections recorded annually. In 2017 alone:

2.3 million new gonorrhoea cases were recorded in women aged 15-49.
1.9 million new cases of chlamydia were reported among women in the same age group.
Among men, there were 2.2 million new cases of gonorrhoea and 3.9 million cases of chlamydia.
Over 70,000 new syphilis cases were diagnosed across both men and women.

Despite medical advancements and increased access to healthcare, these numbers show that STI prevention strategies remain inadequate. One major challenge is that many STIs, such as chlamydia, can be asymptomatic, leading to a cycle of undiagnosed and untreated infections that continue to spread.

The Devastating Impact of STIs

The consequences of untreated STIs can be severe. Beyond the immediate discomfort and complications, these infections can have long-term effects on sexual and reproductive health, including:

Infertility: Untreated gonorrhoea and chlamydia can cause permanent damage to the reproductive organs, leading to infertility in both men and women.
Increased HIV Risk: STIs create an inflammatory response in the body, attracting immune cells to the affected area. This makes it easier for HIV to infect and replicate in the body, significantly increasing the likelihood of transmission.
Pregnancy Complications: Syphilis and other infections can be transmitted from mother to child during pregnancy, leading to stillbirths, premature births, and congenital disabilities.
Social and Psychological Effects: The stigma surrounding STIs can lead to mental health issues such as anxiety, depression, and a reluctance to seek treatment.

Why South Africa Is Struggling to Combat STIs

One of the biggest challenges in South Africa’s fight against STIs is the imbalance in prevention efforts. While the country has been successful in scaling up HIV prevention and treatment, STI prevention has not received the same level of focus. Factors contributing to this include:

Limited STI Screening: Many STIs go undiagnosed because routine screening is not widely implemented, particularly among asymptomatic individuals.
Healthcare Access Issues: Many South Africans, particularly in rural areas, face barriers in accessing client-friendly STI detection and treatment services.
Changing HIV Messaging: The focus on HIV prevention has evolved with the introduction of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). While these advancements have helped control HIV, they do not protect against other STIs, leaving gaps in public health messaging.
Behavioural Factors: Condom use has declined in certain populations, partly due to the belief that ART and PrEP eliminate all sexual health risks.

The Role of USAID in STI Prevention and Treatment

The United States Agency for International Development (USAID) has been a key partner in South Africa’s public health efforts, particularly in the fight against HIV and STIs. Through its PEPFAR (President’s Emergency Plan for AIDS Relief) initiative, USAID has contributed significant funding and resources to improve sexual health services. Some of its key contributions include:

Integrated STI and HIV Programmes: USAID has helped develop integrated healthcare models that provide STI screening alongside HIV prevention and treatment services.
Increased Access to Testing and Treatment: USAID-supported programmes have expanded access to STI testing, particularly in high-risk populations such as young women and sex workers.
Community Outreach and Education: The organisation has supported initiatives that promote STI awareness, encouraging early detection and treatment.
Research and Innovation: USAID has funded research into new STI treatment methods, particularly in response to antibiotic-resistant strains of gonorrhoea.

A Call for Renewed STI Prevention Strategies

To effectively address South Africa’s STI crisis, a multi-pronged approach is needed:

Expanded Screening and Early Detection: Routine STI testing should be a standard part of healthcare visits, particularly for high-risk groups.
Improved Public Health Messaging: Campaigns should emphasise that while HIV is now more manageable, other STIs still pose serious health risks.
Increased Condom Promotion: The consistent and correct use of condoms remains one of the most effective ways to prevent STIs.
Healthcare System Strengthening: More funding is needed to ensure that STI treatment and prevention services are accessible to all.
Stronger Policy and Structural Support: The government must prioritise STI prevention at the same level as HIV, ensuring that funding and resources are distributed effectively.

Conclusion

STIs remain a silent yet dangerous epidemic in South Africa, affecting millions and increasing the overall burden on the healthcare system. While strides have been made in HIV prevention and treatment, STI prevention has been left behind. USAID and other global health organisations have played a crucial role in addressing these challenges, but without a renewed national focus on STI prevention, early detection, and comprehensive sexual health education, the epidemic will continue to grow. It is time for South Africa to take bold, innovative steps to ensure that sexual health is prioritised for all.