Adolescent STIs – Are we meeting the demand for care? (Part 1)
Posted on 25 August 2020
STIs amongst sexually active adolescents is nothing new. But what is new is the rising trend in these numbers.
According Dr Anusha Naidoo, Gynaecological Oncologist at Mediclinic Sandton, youth from 15 to 24 years of age account for a disproportionate number of new sexually transmitted infections and approximately 25% of sexually active adolescent females have already had a sexually transmitted infection.
We look at why this is happening – and where we need to intervene as a country and society to improve education and access to care.
“Adolescence brings a strong desire for autonomy and an increase in sexual risk-taking,” says Dr Naidoo, “This makes them particularly vulnerable to sexually transmitted diseases.” In 2016, young women (ages 15 – 24) made up 37% of new HIV infections in the South Africa.
“In South Africa, sexuality is influenced by the culture in which one lives,” explains Dr Naidoo, “However, now in addition to the knowledge they gain as children from their parents, adolescents move towards peers, media and social networking platforms as their source of information.” This has shown to have a strong association with increased risky sexual behaviour.
Dr Naidoo identifies certain risks factors for STIs specific to adolescents. In addition to biologic factors relating to their adolescence, which may leave them more vulnerable, there are also aspects such as the age of sexual debut. “Early sexual debut, multiple partners, new partners or partners with multiple partners, non-compliance to condom use, alcohol and other drug consumption are all associated with an increased acquisition of STIs.”
But there is often a delay in receiving care when an STI has been contracted. Dr Naidoo highlights the potential reasons for this. “The first is self-treatment, where adolescents are treating themselves incorrectly or inadequately. Added to this is the asymptomatic nature of the STIs – where the adolescent may not be aware of the infection until damage has already been done.” Access to treatment is also hampered by social perceptions – where many public sector facilities are focusing on maternal health, childbirth and HIV, and are not sufficiently geared to readily assist a young patient presenting with a potential STI. Then if the patient does present, healthcare workers are not always sensitive to the personal nature and need for privacy surrounding these issues. “A young girl of 15 may be extremely conscious of the need for privacy and confidentiality and this is sometimes compromised by the care providers’ attitude to the adolescent’s potentially risky sexual behaviour,” according to Dr Naidoo. She continues, “Informing sexual partners is another barrier to treatment, with young girls often opting to inform their partners themselves – which the care giver cannot guarantee will occur – meaning potential re-infection or infection of other partners.”
A further concern is that this delay in care may have long term consequences. “In addition to pelvic inflammatory diseases there are also the risk of adverse pregnancy outcomes such as ectopic pregnancies, spontaneous abortion and fertility issues in both men and women,” explains Dr Naidoo.
She believes that there are important things that need to be put in place to reduce these barriers to treatment. “We can definitely work on treatment for partners and ensuring that patients receive all the necessary treatment. Single dose options that are administered in front of the therapist as well as STI pre-packaged drug kits that can be provided to the patient for their sexual partner. We need to make it simple and easy to adhere to. Currently 30 – 40% of young adolescent girls do not follow through on the script provided – they need to get treatment there and then.”
In part 2 we look at how we can potentially address these challenges as a society.