STI Conditions In Zimbabwe

Introduction and STI situation in Zimbabwe

According to the World Health Organisation (WHO) approximately more than 1 million Sexually Transmitted infections (STIs) are acquired every day worldwide1 WHO also asserts that the common STIs are human immunodeficiency virus (HIV) infection and viral hepatitis2. Worldwide and in Africa, STIs are a major public health concern3. Annually, it is estimated that there are 357 million new cases of the four major curable STIs among people aged 15–49 years in the world: 131 million cases of chlamydia infection, 78 million cases of gonorrhoea, 6 million cases of syphilis, and 142 million cases of trichomoniasis1. In 2008 in African, the total number of new cases chlamydia infection were 8.3 million, 21.1

Gonorrhoea, and postoperative infections, as HIV, are increasingly becoming untreatable because of antimicrobial resistance3,20. Gonorrhea is one of the most common STIs in Zimbabwe and there is rising prevalence of gonococcal antimicrobial resistance21. One study noted that although most men presenting with urethral discharge were initiated on fluoroquinolone-based antimicrobial therapy, approximately 1 in 16 gonococci tested was resistant to this antimicrobial class. During this study, norfloxacin formed part of the empiric treatment of STIs in Zimbabwe, yet the prevalence of microbiologically predicted fluoroquinolone-resistant gonorrhea was above the WHO's 5% resistance threshold for changing first-line therapy21.

Mechanisms of Transmission and control of STIs in Zimbabwe

Unprotected sex puts one at risk of STIs. In one study 48% of women reported they had had condomless sex in the last 7 days before being interviewed7.The occurrence of sexually transmitted infection (STI) syndromes among persons with HIV infection indicates the presence of high-risk behaviors and biological co-factors favoring HIV transmission22.

However, some studies conducted in Zimbabwe found no association between active syphilis and perinatal HIV

Accordidng to a recent population based survey, adults ages 15 to 64 years in Zimbabwe, 3.0 percent of females and 2.4 percent of males have ever been infected with syphilis. Prevalence of active syphilis infection is 1.0 percent among females and 0.6 percent among males ages 15 to 64 years30. (Gonorrhoea prevalence in women of around 2.5% (1.1% to 4.6%) over 1995–2000, followed by a slight rise from 2001, to 3.8% (1.8% to 6.7%) over 2012–20161 Estimated syphilis prevalence (in men and women) declined from 1.9% (95% CI 1.1% to 3.4%) in 2000 to 1.5% (1.3% to 1.8%) in 2016 in Zimbabwe At these time points, gonorrhoea estimates for women aged 15–49 years were 2.5% (95% CI 1.1% to 4.6%) and 3.8% (1.8% to 6.7%) in Zimbabwe29

Younger age and marital status were also important risk factors for incident STIs, with participants younger than 25 years being twice as likely and unmarried participants being 1.5 times more likely to acquire chlamydia. Diagnosis of gonorrhea was also twice as common in women younger than 25 years, but was also 70% more likely in women who consumed some alcohol7. One study from Zimbabwe found HIV prevalence rates of 27% for male inmates, 39% for female inmates and 60% for sex workers, with 9.6% of these getting newly infected between