STIs in South Africa

Despite a high disease burden, STIs receive significantly less attention and funding than HIV and tuberculosis.

At-A-Glance 

• STIs are widespread, yet underdiagnosed due to limited access to diagnostic testing and continued reliance on syndromic management.  
• South Africa primarily uses a syndromic approach (treating symptoms rather than confirming infection), which misses asymptomatic cases, contributes to unnecessary antibiotic use and limits understanding of the true burden.  

The Burden

• South Africa has one of the highest burdens of STIs globally, including chlamydia, gonorrhea and trichomoniasis, all of which contribute to adverse reproductive health outcomes and increased HIV transmission.  
• High prevalence persists across populations, with ongoing transmission driven in part by untreated asymptomatic infections and gaps in routine screening and diagnostics.  

Key Challenges

• Access to STI diagnostics remains limited, with minimal investment in etiological testing beyond syphilis and continued dependence on syndromic management.  
• STIs are deprioritized in funding and policy, with HIV and TB dominating resources, leaving STI diagnostics, surveillance and vaccine preparedness underfunded.  
• Coordination across stakeholders is fragmented, and STI-specific leadership is underdeveloped, limiting effective scale-up of research and programmatic interventions.  
• Surveillance systems are incomplete, with inconsistent data collection and limited geographic coverage, particularly in rural and under-resourced settings.  
• Health system capacity remains constrained, with limited STI-specific training for healthcare providers and insufficient integration of STI services across platforms.  
• STI research and programs are heavily reliant on external funding, making them vulnerable to disruptions, including recent cuts that have halted studies and reduced workforce capacity.  
• Community awareness and advocacy remain limited, with STI-focused engagement often sporadic and overshadowed by HIV programming.  

Opportunities

• There is an opportunity to develop domestic funding mechanisms to safeguard the sustainability of STI research.  
• There is also an opportunity to foster stronger collaboration between academia, the National Department of Health (NDoH), the National Institute for Communicable Diseases (NICD), and the South African Health Products Regulatory Authority (SAHPRA) to accelerate policy translation and regulatory approval of new diagnostic tools.  
• Integrating academic research outputs with national surveillance systems, such as NICD, offers an opportunity to strengthen real-time data use for policy.  
• In addition, encouraging regional academic partnerships across Southern Africa could support shared infrastructure, training, and data exchange.  
• Leveraging international collaborations presents an opportunity to build capacity and advance knowledge exchange while ensuring long-term local ownership. 

Advocacy Partners

In South Africa, government, research institutions and civil society partners are using advocacy to elevate STIs and are driving stronger coordination, increased investment and more community-informed, evidence-based responses. The South Africa advocacy agenda was developed in partnership with Mandisa Mdingi and Alex de Voux from South Africa. Mdingi is a nurse, public health research, and STI advocate and de Voux is a public health researcher and infectious disease epidemiologist, South Africa