Policies to strengthen S.T.I. control needed: W.H.O.
More needs to be done to control the spread of sexually transmitted infection (S.T.I.) prevalence in Samoa, the authors of a landmark study have said.
Authors of the first, national-level study estimating the prevalence of a variety of S.T.I.s in four Pacific states, say new S.T.I. policies must be considered in order to see a real decrease in the infections rates.
According to the report, which measured the prevalence of certain S.T.I.s, rates of chlamydia infection in Samoa remain stubbornly high.
The report measures rates of infection between 1999 to 2017. It found the rates of chlamydia infection in Samoa has fallen slightly in that time from just under 34 per cent of all women to 30.6.
Samoa had the lowest prevalence, in syphilis, but the highest in chlamydia; rates of chlamydia infection had fallen significantly in other countries such as Fiji and Papua New Guinea. Rates also did not fall in the Federated States of Micronesia but remained significantly lower than in Samoa at 24 per cent of all women.
Untreated chlamydia can cause pelvic inflammatory disease, infertility and fatal pregnancy and experts have warned it could affect Samoa’s future fertility on a national scale.
Despite chlamydia showing no significant decline, authors of the paper said S.T.I. programmes in Samoa needed to focus on all diseases, not just chlamydia.
“The approaches to prevent and treat sexually transmitted infections (S.TI.s) should focus not only on chlamydia but also on syphilis, gonorrhoea and human papilloma virus (H.P.V.) which causes cervical cancer,” Dr. Takeshi Nishijima wrote in response to questions from the Samoa Observer and on behalf of all 12 authors of the study.
Critically important policies needed for Samoa include integrating S.T.I. services into general health services, such as reproductive health services like family planning and prioritising and extending services to not only treated cases but their sexual partners through contact tracing, the experts said.
Raising awareness and education around S.T.I.s, addressing the stigma and discrimination around S.T.I.s, and securing long-term funding for anti-S.T.I. programmes should also be priorities the authors said.
Similar methods of reducing S.T.I. prevalence in Samoa were nominated by the Pacific Community's (SPC) Silina Motofaga.
"Apart from the sentinel surveys that were conducted in early 2000, another study indicated was in 2015 and then the 2017 [antenatal] clinic screening. It is difficult to comment on why Samoa has high rates, from this study alone. It will be good to look at other recent STI studies, to understand the reasons why," she said.
"Factors such as social stigmatisation of STIs and testing, cultural barriers, behaviour changes and lack of community and population interventions to reduce the prevalence could be reasons why rates of chlamydia are still high.
Authors of the landmark study say controlling gonorrhoea and chlamydia in high prevalence populations require services beyond clinical treatment and passive clinic-based surveillance, including active outreach, screening of all higher-risk populations, and strengthening partner management, including presumptive treatment.
Samoa’s effort towards eliminating the three major bacterial S.T.I.s was noted by the study authors to have been hampered by low awareness among target populations, and the lack of strategy for partner tracing.
Study authors suggest that increasing antenatal care attendance and ensuring all pregnant women are screened for syphilis early in pregnancy is important.
“It is desirable to screen for gonorrhoea, chlamydia, and H.P.V. as well. If a woman’s test results are positive, her sexual partner(s) should be tested and treated,” Dr. Nishijima wrote.
“Reproductive health services and postnatal services present good opportunities for S.T.I. screening.”
Though nothing beats the traditional preventative response of encouraging the use of sexual health products such as condoms, prevention is better than cure, the authors said.
“Encouraging condom use for protection against S.T.I.s, for adolescents in particular, and ensuring these are available and distributed through communities and outreach services for these and other specific populations," Dr. Nishijima continued.
“Ensuring and promoting primary prevention through access to [Human Papillomavirus] vaccination (prioritising girls within the age range 9 to 14 years) and hepatitis B vaccination for all infants, since hepatitis B infection can be transmitted as S.T.I..”
According to Dr. Nishijima, initially, the study was planned to estimate prevalence for both men and women, but due to a lack of data for men, they were only able to estimate prevalence for women.
University of New South Wales Professor Heather Wolf had earlier said such high figures for chlamydia in Samoa are a real threat to the future population of Samoa.
"We don't really know what the rates are with men so we only make sense that nearly 1 in 3 women of childbearing age has chlamydia, it could be a little less or a bit more but basically what it means is that there is a likelihood of a decrease in fertility and more ectopic pregnancy in women who have chlamydia," she said.
In a comparative table in the report, Samoa was found to have the lowest rates of active syphilis among all nations studied but there was a slight increase in its estimated prevalence over the years (from 0.14 per cent in 2000 to 0.16 per cent in 2017). Rates of gonorrhoea have also fallen slightly to reach 1.6 per cent.
The study was authored by Takeshi Nishijima, Devina Nand, Nefertti David, Mathias Bauri, Robert Carney, Khin Cho Win Htin, Ye Yu Shwe, Anup Gurung, Guy Mahiane, Naoko Ishikawa, Melanie M Taylor and Eline L Korenromph.