According to the National Guidelines for the Management of STIs jointly prepared by the Federal Ministry of Health and Federal HAPCO, sexually transmitted infections are caused by more than 30 pathogens that can be transmitted through unprotected sex. STIs may be broadly classified into ulcerative and non-ulcerative (discharge) or curable and non-curable (MoH, 2006). While it’s easy to prevent the transmission of non-ulcerative or discharge STIs through the correct and consistent use of condoms, it’s rather difficult to prevent the transmission of ulcerative STIs, as open sores and infected parts may be found in areas where condoms cannot cover. Thus, in such cases the best prevention method is abstinence. STIs are especially more severe on women as the consequence of some STIs may result in cervical cancer, death during child birth and child infection during pregnancy or childbirth.
Although the Ethiopian government has come up with a National guideline to treat and care for STIs by using syndromic approach – an approach that uses a set of symptoms to treat possible cases of STIs by giving medications believed to be the appropriate treatment, STIs that do not show sufficient symptoms with potentially fatal consequences may be left undetected. Such an approach, albeit best in a resource limited country as Ethiopia, where availability of fully equipped laboratories are very limited and skilled health care practitioners are hard to come by, it may not treat or address a lot of people’s problems with asymptomatic STIs.
Furthermore, because the presence of STIs, especially ulcerative STIs, exacerbates the risk of acquiring HIV, as the open sores and cuts provide easy access for the HIV virus to pass into the blood stream in cases of unprotected sexual intercourse, early diagnosis is important to prevent HIV acquisition.
According to a WHO factsheet published in August 2011, “the presence of untreated STIs (both those which cause ulcers [and] those which do not) increase the risk of both acquisition and transmission of HIV by a factor of up to 10. Thus, prompt treatment of STIs is important to reduce the risk of HIV infection” (WHO, 2011).
Therefore, in sero-discordant relationships, where one partner is HIV positive and has other STIs, the chances of transmitting HIV to their uninfected partner increases, if the STI is not treated promptly. The same is true, for the HIV negative partner who has an untreated sexually transmitted infection.
To see how much testing for STIs embarrasses people, we spoke to one college student in Addis Ababa. *Zeinab is a twenty year old college student who has been going out with her boyfriend for a couple of years, whom she plans to marry. Although, Zeinab is still a virgin, she has had several intimate moments with her boyfriend without having actual sexual intercourse. Because of this, Zeinab used to feel that she would be safe from all STIs and, thus, did not see the need to seek medical help. It wasn’t until Zeinab decides to volunteer in an organization that works in the area of HIV/AIDS that she finds out she may be at risk of acquiring STIs. Because she has no symptoms and most STI tests use the syndromic approach, she does not know how to get tested or what to tell the doctors. Embarrassed and worried, she’s waiting for the time when she gets married and has the freedom to ask for all possible tests.
Although, Zeinab has already decided to marry her boyfriend and is HIV negative at the time being, she nonetheless feels that talking about STIs and getting tested is difficult in such a traditional society as ours. She also feels that although much is being done about HIV on various media, there is hardly anything on STIs and on how to prevent them.
Adolescents who start sexual intercourse at an early age are at higher risk of acquiring STIs because they are not in a good position to negotiate for safer sex and due to the increased number of sexual partners they will have in their lifetime.
With this in mind, more awareness raising work needs to be done in schools, colleges and youth clubs to inform the more susceptible population on the dangers of STIs, how STIs are transmitted and on how to prevent them.
*Names in this article have been changed to protect identity.
