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By Annonciata Byukusenge

In different area villages, the majority of people treated for sexually transmitted infections (STIs) are women. Some of them don’t have enough information about STIs, others confuse STIs with local myths known as (Ifumbi) as women talked with Forefront Magazine.

Sexually transmitted infections (STIs) are caused by bacteria, viruses, or parasites that are transmitted through unprotected sex (vaginal, anal, or oral) and skin-to-skin genital contact. Zika Virus can also be sexually transmitted. Travel Health Information: Rwanda

More than 30 different bacteria, viruses, and parasites are known to be transmitted through sexual contact, including vaginal, anal and oral sex. Some STIs can also be transmitted from mother to child during pregnancy, childbirth, and breastfeeding. Eight pathogens are linked to the greatest incidence of STIs. Of these, 4 are currently curable: syphilis, gonorrhea, chlamydia and trichomonas’s. The other 4 are incurable viral infections: hepatitis B, herpes simplex virus (HSV), HIV, and human papillomavirus (HPV). According to the World Health Organization (WHO). Sexually transmitted infections (STIs)

STIs syndromes

They include anal discharge, urethral discharge in men, vaginal discharge, Genital ulceration, inguinal bubo, Painful swelling of the scrotum, Pelvic pain in women, Venereal vegetation or growth (Condylomas), and Purulent conjunctivitis of the newborn.

The 2019–2020 Rwanda Demographic Health Survey (RDHS) estimated that about 4.4% of the general population between 15–49 years old reported having at least one STI symptom during the last 12 months before the survey. The findings showed that in Huye district 4.8% of women reported to the Health Center and 0.5% of men reported to the Health Center.

Rukira Health Post is one of 1,179 health posts that provide basic health services nationwide to underserved communities.

A 17-year-old called Hope Gloriose lives in Huye district, Rukira cell. She is suffering from sexually transmitted infections (STIs). Before 16 years this girl was safe because she didn’t do sex.

“After having sex in 2022, every three months I have to go to the health Center for treatment of trichomonas. When I do sex I feel well, but after having sex, I have so much pain in my vagina. The doctor told me that it is a sexually transmitted disease, and I should stop doing it until I am married or use a condom during sex.”

This lady is suffering from sexually transmitted infections (STIs), but she doesn’t live with HIV though she is at risk of acquiring it.

She added that poor sanitation contributes to STIs. Rukira cell is one of the cells in Huye district that has water near the community, but Rukira has many women suffering from sexually transmitted infections (STIs) without HIV.

Clementine Nyiramana is 35 years old. She is suffering from sexually transmitted infections (STIs). Her daily work is farming. 

Every morning she goes to the farmer without cleaning her genitals. In conversation with her, she said that she can buy soap, body lotion, and water, but she doesn’t have the attitude of cleaning her genitals.

“On my side, I can’t find the time to clean my genitals every morning. I wake up at 5h00 AM, carry my shed, and then go to my farmer immediately. How can I start the day by taking a shower? For me, it is to spend my time for nothing. Remember that I am a woman farmer, I am not an office woman.” 

The behavior of Nyiramana is common to her colleague Kabanyana who lives in the Muyogoro cell in the Huye sector. She highlighted the cause of poor sanitation for rural women.

“Everyone has to know that in rural areas we do overall activities, it is not the same in cities. A rural woman wakes up in a shed for the farmer, at noon back home with firewood, water, a goat, and a bucket containing potatoes for preparing lunch for her family. After lunch at 2 PM she returns to the farm to plant seeds till 5h or 6 PM. At the end of the day, this woman is very tired, but she has to prepare dinner for her family and take care of her kids because they leave school at 5 PM. Where is the time to take a shower or clean my genitals for this woman?” 

 She added that lack of information about STIs contributes to them because they don’t know how to prevent STIs and they need enough information on STIs.

STIs awareness, testing and treatment in Rwanda 

STI management is a cornerstone in the fight against HIV and HBV, as they share similar modes of transmission. Rwanda has adopted systematic screening of all people visiting health facilities to increase the unmet need for STI-related services, mainly due to cultural barriers and stigma. Five syndromes have been adopted by WHO for oral screening, physical examination, treatment, and reporting. 

From July 2022 to June 2023, over four million people have been screened for STIs, of whom 224,460 (5.3%) had one or more STI signs and/or symptoms. The Western province recorded the highest number of screened people (1,151,305) and the lowest number was recorded by the City of Kigali, 415,603, the latter having the highest positivity rate (9.7%), which is not surprising given that HBV and HIV are also widespread in this capital city.

STIs syndromic management

In terms of syndromic management, vaginal discharge tops the list, followed by urethral discharge in men, the latter reflecting a possible spread of STIs requiring greater awareness and better treatment.

Forefront Magazine visited Rukira Health Center in Southern province, Huye district, in the Huye sector. An interview with its Director Cyprien Ndibwirende, said that they receive many people who need sexually transmitted infections (STIs) treatment.

“The majority of people we treat for sexually transmitted infections (STIs) are women. In general, we receive people between 30 and 45 per month. Those suffering from STIs include men, young girls, and women without HIV. A large number of ladies are between 19 and 45 years old.”

Ndibwirende added that the majority of people they treat are not aware of the STIs. “Some of them say that it is a normal sickness for women and call it ‘Ifumbi’, others say allergies. After treatment, we inform them about STIs, their causes, symptoms, and their preventions, because STIs are a major public health concern and constitute a high risk of HIV transmission. Therefore, they should be timely and efficiently prevented, diagnosed, and treated.”

Scope of the STIs globally 

According to the WHO Sexually transmitted infections (STIs), more than 1 million STIs are acquired every day the majority of which are asymptomatic. In 2020, WHO estimated 374 million new infections with 1 of 4 STIs: chlamydia (129 million), gonorrhea (82 million), syphilis (7.1 million), and trichomonas (156 million). More than 490 million people were estimated to be living with genital herpes in 2016, and an estimated 300 million women have an HPV infection, the primary cause of cervical cancer and anal cancer among men who have sex with men. An estimated 296 million people are living with chronic hepatitis B globally.

Scope of the STIs in Africa 

Sub-Saharan Africa ranks first in STD yearly incidence compared to other world regions. The World Health Organization has estimated that every year in Africa there are 3.5 million cases of syphilis, 15 million cases of chlamydial disease, 16 million cases of gonorrhea, and 30 million cases of trichomonas.

Scope of the STIs in Rwanda 

At the national level, the prevalence of STI syndromes among individuals screened at health facilities in Rwanda is estimated at 5.3% countrywide. Dr Charles Berabose said. 

Prevention of Sexually Transmitted Infections

Primary Prevention: Reduction of the Risk of Infection

  • Reduction of the number of partners
  •  Low-risk sexual  behaviors
  • Consistent and correct use of condoms
  • Counseling for male circumcision

Secondary Prevention of STIs

This is the prevention of STI complications and constitutes the primary prevention of HIV infection

  • Promotion of the attitude to seek treatment
  •  Provision of quality care services
  • Offer of support and counseling services

People have a risk of being affected by STIs

Female Sexual Workers (FSW)

Sex workers are vulnerable groups and core groups for the transmission of STI and HIV. Their care and treatment is a process that is both classic and specific. It is specific, given the profession of sex workers and the prevalence of STI/HIV in women. Consequently, active diagnosis of STI is highly recommended.

In practice, presumptive treatment of the commonest and the most morbid STI (risk of Pelvic Inflammatory Syndrome, infertility) is recommended during the first visit in the absence of obvious clinical signs of STI. (See specific algorithm).

Men Who Have Sex with Men (MSM)

MSM, including those with HIV infection, should routinely undergo nonjudgmental STI/HIV risk assessment and client-centered prevention counseling to reduce the likelihood of acquiring or transmitting HIV or other STIs.

Dr Charles Berabose, a staff from the unit in charge of Other Blood Borne Infections and   STIs at Rwanda Biomedical Center (RBC), said that they regularly conduct awareness campaigns to break myths around STIs and highlight preventive measures including care and treatment.

“Some women don’t have enough information on STIs and call it ‘Ifumbi’, but we are encouraging people to consult health facilities around them in case of STIs signs and symptoms. Proper testing and treatment services are readily available. Therefore, people should not delay medical consultation while taking traditional herbs and consulting traditional healers as this leads to late medical assistance seeking with some irreversible complications.”

About the young girls suffering from trichomonas after having their first sex, Dr Berabose said that is a myth, that trichomonas can be acquired anytime provided that unprotected sex is done and there is a partner who is suffering from the infection.

The policy stipulates that health providers are to do the following:

– Follow up with partners of the client as a part of treatment;

–  Adhere strictly to the protocols for dosage and duration of treatment;

– Encourage the client to complete the full treatment; and

– Advise the client to abstain from sexual activities until completing the treatment and, after completing treatment, to adopt safe sexual practices (including abstinence and fidelity/faithfulness between couples).

The policy recognizes that addressing STIs decreases the risk of HIV/AIDS infection. Mobilizing the community and raising awareness to prevent transmission are policy priorities that involve politicians and administrators, NGOs, international organizations, and religious communities. National Guidelines for Prevention and Management of HIV and STIs

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