title: Opportunities for treating sexually transmitted infections and reducing HIV risk in rural South Africa.
abstract: OBJECTIVE
  This paper is a report of a study to determine the aetiological distribution of sexually transmitted infections and prevalence of human immunodeficiency virus infection in selected primary health care clinic attendees.
  
  
  BACKGROUND
  South Africa has a high prevalence of human immunodeficiency virus and other sexually transmitted infections. Sexually transmitted infections are managed syndromically in the public sector as part of the essential nurse-driven primary care services provided at no cost to the client.
  
  
  METHODS
  This cross-sectional study was conducted in a rural community in South Africa between September and November 2002. A total of 277 consenting women were recruited. Vulvo-vaginal swabs were collected for screening for Neisseriae gonorrheae, Chlamydia trachomatis and Trichomonas vaginalis using DNA amplification methods and Gram stain with Nugent's score for the diagnosis of bacterial vaginosis. Seroprevalence of syphilis and human immunodeficiency virus infection were determined.
  
  
  RESULTS
  The overall prevalence of human immunodeficiency virus in the study was 43.7% (95% confidence interval 37.6-50.0) with the prevalence in family planning clinic attendees 45.5% (95% confidence interval 38.9-52.3) and antenatal clinic attendees 33.3% (95% confidence interval 19.6-50.3). The prevalence of sexually transmitted infections amongst both the antenatal clinic and family planning attendees accounted for at least 70% of cases. Fifty per cent of women had one recognized sexually transmitted infection with 17.9% of the family planning and 14.5% of the antenatal clinic attendees having infections from two recognized pathogens. All infections were asymptomatic.
  
  
  CONCLUSIONS
  Nurse-driven antenatal and family planning services provide a useful opportunity for integrating reproductive health services, human immunodeficiency virus voluntary counselling and testing and treatment of sexually transmitted infections.
authors.affiliation: Centre for AIDS Programme of Research in South Africa (CAPRISA), School of Nursing, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, Congella, South Africa. frohlichj@ukzn.ac.za
authors.forename: J A
authors.initials: JA
authors.lastname: Frohlich
authors.forename: Q
authors.initials: Q
authors.lastname: Abdool Karim
authors.forename: M M
authors.initials: MM
authors.lastname: Mashego
authors.forename: A W
authors.initials: AW
authors.lastname: Sturm
authors.forename: S S
authors.initials: SS
authors.lastname: Abdool Karim
mesh_terms: D000328:Adult; D000818:Animals; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008403:Mass Screening; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D012423:Rural Health; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology; D014247:Trichomonas Vaginitis / Q000175:diagnosis* / Q000453:epidemiology; D014246:Trichomonas vaginalis / Q000302:isolation & purification; D014621:Vagina / Q000382:microbiology / Q000821:virology