We Need More Education on STIs to Avoid Antimicrobial Resistance

There is a need for continuous awareness and public sensitization to improve knowledge on sexually transmitted infections (STIs) and reduce its spread in the country, a new study has said.

Consequently, it has recommended targeted interventions to improve STI treatment for better outcomes to minimize risks of antimicrobial resistance, a growing public health threat in the country.

Titled, “Knowledge and prevalence of common sexually transmitted infections among patients seeking care at selected health facilities in Southern Ghana” and published in PLOS Global Public Health, the research identified demographic and behavioural characteristics such as marital status and smoking as highly associated with the risk of contracting an STI. 

According to the World Health Organisation (WHO), STIs such as chlamydia, gonorrhoea, syphilis, and trichomoniasis, have serious reproductive health consequences, including infertility, mother-to-child transmission, adverse birth outcomes (including still and newborn deaths), increased risk of HIV acquisition, as well as cancer.

These diseases are spread predominantly by sexual contact, including vaginal, anal, and oral sex while other STIs can also be spread through non-sexual means, such as via blood or blood products, as well as from mother to child during pregnancy and childbirth.

Common symptoms of STIs include vaginal discharge, urethral discharge or burning in men, genital ulcers, and abdominal pain. The majority of STIs have no symptoms.

Studies by the WHO show that more than 1 million curable STIs are acquired every day worldwide in people between the ages of 15–49, the majority of which are asymptomatic.

In 2020, the WHO said there were an estimated 374 million new infections in people 15–49 years, with 1 of 4 curable STIs, chlamydia, gonorrhoea, syphilis and trichomoniasis.

The research established that “sexually transmitted infections impose a significant burden of illness and death in numerous developing nations.”

These diseases, they said, impact reproductive and infant health, as well as their contribution to the spread of the Human Immunodeficiency Virus (HIV) infection, adding that, “understanding STIs and their potential repercussions is crucial for effective prevention and treatment.”

The authors employed facility-based cross-sectional study, using a validated and well-structured, pretested, open and close ended questionnaire for data collection from patients visiting three health facilities – the Ho Teaching Hospital, Ho Municipal Hospital and Ho Polyclinic in the Ho municipality.

They used patients with suspected cases of STI visiting these health facilities. Annually, the three facilities have an average of 60,000, 30,000 and 24,000 patients respectively. Patients between 18 and 65 years who visited the three hospitals with STIs and were willing to participate in the study were included.

The patients (study participants) were recruited after consultation with a physician who also briefly introduced the study to the patient before the patient went to the pharmacy for his/her medications.

The participants’ symptoms included lower abdominal pain (females only), pain during urination, genital sores, or discharges from the penis or vagina. Excluded were persons who are unable to carry out self-care or receive medication by themselves.

The sampling method was employed to ensure every patient had an equal opportunity to take part in the study, minimize potential biases, and achieve a thorough representation of the study population. Participants were made to pick from an envelope containing folded shuffled papers with ‘Yes’ or ‘No’ written on them to select those who wanted to be included in the study.

They found during their analysis that the gender and marital status of the participants were statistically associated with the risk of sexually transmitted infection among the respondents. Additionally, females were 60% less likely to be at risk of STI infection compared to males, and married participants were 58% less likely to be at risk of STI compared to unmarried participants.

Smokers were 8.5 times at risk of STI infection compared to nonsmokers and having two or more past relationships, increased the risk of STI two folds compared to having less than two past relationships.

Lead researcher and clinical pharmacist, Dr. Araba Hutton-Nyameaye, in an interview, raised the critical need for policymakers to devise interventions targeted at improving the knowledge of the citizenry on STIs, focusing on preventive measures as well as access to safe treatment options.

Dr. Hutton-Nyameaye said an even greater public health effect from the surge in STIs in the country was its impact on antimicrobial resistance (AMR) due to self-medication among infected people.

“There is concern that the practice of self-medication may be a factor in the emergence of antibiotic-resistant human pathogens and treatment failure. Close to half of the participants in the study resorted to taking medications without consulting a doctor,” she said.

Dr Hutton-Nyameaye, who is also a lecturer at the University of Health and Allied Sciences (UHAS), Ho, said “some of the pathogens of STIs, such as gonorrhoea are no longer responding to medicines hence, this makes it difficult to treat the infection, and infected persons end up having serious complications and spreading the disease to other people knowingly or unknowingly.”

“STIs are real and can cause a lot of problems to us, the society, and the country as a whole hence we should practice safe sex such as condom use,” she added.

A Ho-based mason, who has recovered from STI (and does not want to be identified) said, no one should be afraid, and thus delay in seeking treatment from health facilities. According to him, “Even if you trust the person, you are having sex with. Even if you think the odds are in your favour, it is always best to protect yourself from STIs.”

He said the lessons gleaned from his treatment and recovery journey serve as a wakeup call. “Even if you trust the person, you are having sex with. STIs can hurt a lot, and waiting for the results to come back can turn out to be some of the longest days of your life.

Anyone can get or have an STI. You may hear all kinds of stories of people winging it, but this is some fire you do not want to play with. Always use a condom,” he advised.

BY ABIGAIL ANNOH