Sexually transmitted disease syndromes in rural South Africa: results from health facility surveillance.

Routine health facility surveillance of sexually transmitted diseases (STDs) is essential to define priorities plan services and resource allocation design interventions and monitor program impact. To obtain baseline data and inform the design of an STD control program in rural South Africa this study monitored 4781 symptomatic STD patients recruited in a 5-month period in 1996 from all 15 public primary health care health facilities (n = 3126 episodes) and 8 of the 12 private general practices (n = 1655 episodes) in the Hlabisa health district. The mean ages of male and female STD patients were 26.3 years and 28.7 years respectively; 3592 (75%) were single. 4007 patients (84%)--but only 2677 (56%) of their sexual partners--were district residents. Annual STD incidence was estimated at 9% in both men and women. The highest age-specific incidences for both men and women were found in the 20-24 year age group: 15.4% and 16.4% respectively. Discharge was the most common symptom in both men and women followed by ulcer (in men) and pelvic inflammatory disease (in women). The mean duration of symptoms was 18 days in women and 10 days in men. 1209 patients (25%) reported another STD in the previous 3 months. Extrapolation of these data suggests that 13956 STDs are diagnosed in this rural district each year. Clinics treat 54% of the episodes and general practitioners the remaining 46%. Further research is recommended to identify the factors associated with choice of service provider.