1. What is this study about?

This sentinel surveillance project aims to investigate the microbiological causes and patterns of antimicrobial resistance linked to three major sexually transmitted infection (STI) syndromes: male urethritis syndrome (MUS), vaginal discharge syndrome (VDS), and genital ulcer syndrome (GUS). It is a collaborative initiative led by the Centre for HIV and STIs at the National Institute for Communicable Diseases (NICD), in partnership with the University of the Witwatersrand, the National Department of Health (NDoH), the World Health Organisation (WHO) through its Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), and provincial Departments of Health in the relevant provinces.

The surveillance study generates data on:

• The aetiological causes of STI syndromes,
• The antimicrobial susceptibility profiles of Neisseria gonorrhoeae isolates, and
• The prevalence of HIV, syphilis, hepatitis B virus (HBV), herpes simplex virus type 2 (HSV-2), and human papillomavirus (HPV) genotypes among affected individuals.

This work aims to guide national STI management guidelines and inform timely public health interventions.

2. Why does this matter?

The STI surveillance study directly supports the objectives outlined in South Africa’s National Strategic Plan on HIV, STIs, and TB (2023–2028). By collecting and analysing data from these sites, we can monitor trends in the aetiological causes of STI syndromes, detect emerging drug resistance, and refine syndromic management guidelines. This will ultimately contribute to reducing the incidence of STIs, improving population health, and strengthening the health system’s response to sexual and reproductive health challenges.

3. How did the surveillance come about?

This initiative traces back to 2007, when the need for systematic microbiological surveillance of STIs in South Africa became increasingly apparent. Over time, this study evolved into a more structured, multi-partner programme designed to integrate laboratory-based surveillance with field epidemiology. The inclusion of South Africa in the WHO’s EGASP programme has further strengthened the country’s capacity to detect antimicrobial resistance in Neisseria gonorrhoeae at an early stage.

4. What was your role in the study?

As the principal investigator and interim project lead, I am responsible for overseeing all aspects of the STI surveillance programme. This includes supervising NICD staff, managing relationships with international, national, and provincial stakeholders, developing and updating the STI surveillance study protocol as needed, and ensuring compliance with ethical and regulatory requirements.

5. Why should people read this article?

This article provides insights into the evolving landscape of STIs in South Africa, including emerging Neisseria gonorrhoeae resistance patterns that could impact current treatment strategies. Policymakers, clinicians, and public health professionals will benefit from understanding how microbiological data is being used to support evidence-based decisions. For researchers, the article offers a model for collaborative, multi-site surveillance efforts that link laboratory data with clinical and behavioural information. Ultimately, it highlights how surveillance can be a powerful tool for improving patient care and public health outcomes.

6. What impact do you hope this surveillance will have on public health policy and access to healthcare?

Our goal is to generate reliable data that can directly inform public health policy. Surveillance outcomes will support timely revisions to the national syndromic management guidelines, ensuring they reflect current resistance patterns and aetiological data. This will help to improve treatment outcomes, reduce transmission of STIs and optimise the use of antibiotics.

Dr Etienne Müller is a Principal Medical Scientist at the Sexually Transmitted Infection Section in the Centre for HIV & Sexually Transmitted Infections at the National Institute for Communicable Diseases. 

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