Are we having important sexual health conversations?

There are many conversations that are encouraged at the start of a new relationship, but few are as important as the conversation around sexual health.

While this is a sensitive conversation that may be shrouded in stigma and shame, the vulnerability to be open ensures your sexual health and wellbeing are protected and the foundation of your new romance — or longer-term partnership — is built on transparency and trust.  

South Africa is the epicentre for HIV infection and has some of the highest incidence rates of sexually transmitted infections (STIs) in the world. Dr Anusha Naidoo, Obstetrician and Gynaecologist at Mediclinic Sandton says it’s difficult to estimate the actual extent of sexually transmitted diseases (STDs) and infections (STIs) in the absence of controlled tests. However, she warns that many patients have asymptomatic diseases, which increase the risk of complications and exacerbate transmission. “Screening is imperative to identify and treat individuals who may be unaware that they are infected and who would otherwise go undetected. This is an especially pertinent approach to individuals in high-risk groups.”

Common sexual health risks in SA

Higher at risk for the transmission of STIs include men who have sex with men (MSM), people who have been exposed to illicit drug use, have a history of STIs or are HIV-positive, pregnant women, and individuals who have previously been admitted to a correctional facility or juvenile detention centre. The risk of STIs is particularly high among sexually active adolescents and young adults between the ages of 15 and 24 years old.

There are also certain behavioural factors that increase the risk of STI infections. These include having a new sexual partner in the past 60 days and having multiple sexual partners or a partner with multiple concurrent sexual partners. Other factors include no- or inconsistent condom use outside a mutually monogamous sexual partnership, sexual contact with someone who was recently treated for an STI, sexual contact (oral, anal, penile, or vaginal) with sex workers, trading sex for money or drugs and meeting anonymous partners on the internet (i.e., via dating apps).

Conditions that can occur because of previously untreated ЅTІs include upper genital tract infections, infertility, chronic pelvic pain, cervical pre-cancer and cancer, and chronic infection such as hepatitis viruses and HІV. 

Take proactive measures to safeguard against risks

The World Health Organization (WHO) has asserted that condoms are one of the most effective means and an essential component in public health strategies to prevent ЅTΙs. “However, these must be used consistently and correctly to be effective,” says Naidoo, who advises using condoms regardless of whether other birth control methods are involved.

She adds that consistent and proper condom-use is estimated to prevent ΗІV transmission by approximately 80% to 95%. It also prevents the transmission of infections like gonorrhoea, chlamydia, trichomonas, genital herpes, human papillomavirus (HPV), and syphilis.

Proper use includes either a latex condom (not to be used after the expiration date or five years since the manufacturing date); using a new condom for each sex act, handling the condom carefully to avoid tears or damage, and placing the condom on a penis prior to genital, oral, or anal contact with a partner.

Adequate lubrication should be ensured, and only water-based lubricants should be used with latex ϲοոԁоms because oil-based lubricants (such as petroleum jelly and mineral oil) can weaken latex. Both water- or oil-based lubricants can be used with polyurethane ϲοոdоmѕ. It’s also important to note the availability of female condoms for additional protection – which are not as widely discussed as male condoms.

Screening and vaccination guidelines

Vaccinations are an effective preventive measure against certain STIs, such as for hepatitis A and B and HPV. However, vaccines for infections such as chlamydia, gonorrhoea, syphilis, and HIV remain unavailable. Some studies suggest that the meningitis B vaccine may offer partial protection against gonorrhoea, but further research is still needed.

Regular screening is therefore essential for detecting and preventing STI transmission, particularly for high-risk individuals, including sexually active young adults, MSMs, individuals with multiple partners, and those with a history of STIs. The frequency of screening depends on risk factors, but all individuals whose partners have been diagnosed with an STI should undergo testing.

Women under 25 should be screened annually for chlamydia and gonorrhoea, while those over 25 should be tested based on risk. Pregnant women require routine STI testing to prevent complications. MSMs should be screened at least annually, or more frequently if at a higher risk.

As Naidoo concludes, screening is not something that happens only in a medical setting but should start with a conversation: “Regardless of relationship structure —monogamous, open, or polyamorous— consistent condom use, open communication, and regular STI testing are key to maintaining sexual health and preventing transmission.”