Changes in the Patterns of Sexually Transmitted Infection among South African Mineworkers Associated with the Emergence of the HIV/AIDS Epidemic

Abstract

OBJECTIVES: To study temporal changes in the relative prevalence of STI syndromes and the aetiology of genital ulcer disease (GUD) among migrant minerworkers in a gold mining area in South Africa during the period1992 – 2000 and to explore the epidemiological synergy and interactions between these conventional STIs and the emergence of HIV infection.
METHODS: The records of all STI patients presenting with new episodes of STI seen at a dedicated STI clinic in the Carletonville area, near Johannesburg between 1992 and 2000 were reviewed and analysed. In addition, cross-sectional studies to determine the aetiology of genital ulcerations were conducted.
RESULTS: During the study period, 36,686 new STI episodes were treated at the clinic with a mean annual STI incidence rate of 137.4 per 1000 miners. The STI incidence remained high throughout the period 1994–9. A total of 35,789 HIV tests were performed during the study period and the overall HIV prevalence was 35.3%. Between 1986 and 1994, the relative prevalence of genital herpes rapidly increased among GUD patients co-infected with HIV: 0% in 1986, 4.7% in 1990 and 20.8% in 1994.
CONCLUSIONS: Syndromic and microbiological surveillance indicates that there was a high incidence of non-herpetic genital ulcerations among miners during the early phase of HIV epidemic. This sustained high incidence of GUDs was followed by a rapid increase in HIV prevalence and with changes in the aetiology of the STI syndrome.