Sexually Transmitted Infections Reference Unit (STIRC)


Last update: September 2007




About STIRC



The Sexually Transmitted Infections (STI) Reference Centre is a dedicated unit within the National Institute of Communicable Diseases.

The unit has three divisions consisting of:
  1. an STI laboratory, which has both routine and molecular capabilities for the diagnosis of all major STI pathogens
  2. a surveillance section consisting of epidemiologists, surveillance officers and data clerks
  3. a clinical section which consists of nurses and doctors involved in departmental STI projects
The unit's main functions include microbiological and clinical surveillance of STIs, provision of reference laboratory facilities for the diagnosis of STIs, clinical and microbiological research on STIs and HIV/AIDS, teaching and training. The unit has published widely over several decades in international peer-reviewed journals.

Current surveillance activities include establishing a national programme for the microbiological surveillance of STIs in South Africa, in collaboration with the National Department of Health (NDoH) and other key University microbiology departments within the country. The Gauteng STI Clinical Surveillance Programme, now in its 13th year, is run from the STI Reference Centre in collaboration with the Gauteng Department of Health. The STI Reference Centre has recently assisted the governments of Swaziland, Lesotho, Namibia and Botswana by providing technical expertise to help improve existing clinical surveillance programmes for STIs within each country. The unit also provides, as required, technical assistance to the Departments of Health in adjoining SADC countries with their microbiological surveillance programmes.

The STI Reference Centre's research programme has a number of key areas including the validation of new diagnostic tests for STIs, assessment of STI burden in informal settlements and townships, studies on the aetiology of the main STI syndromes and the determination of antimicrobial resistance in gonococci, studies on periodic presumptive therapy (PPT) and HIV testing in women at high risk of STIs around gold mining communities and research on the interaction between STIs and HIV/AIDS. A study to assess the impact of adding acyclovir to current syndromic management of genital ulcer disease in South African men was recently completed.

The STI Reference Centre also functions as the African Regional Headquarters of the International Union against STIs.

Contact Us

Staff

Projects Updates

Conferences and Presentations

Links

Contact us

Please direct any queries via one of the following:


Postal Address:
NICD - STIRC,
Private Bag X4,
Sandringham,
2131,
South Africa


Street Address:
STIRC,
Block F,
1 Modderfontein Road,
Sandringham,
2192,
South Africa

Telephone: +27 11 555 0468

Facsimile: +27 11 555 0470

e-mail:
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Staff

Professor David Lewis, Head of Department


Profile



Professor David Lewis The STIRC team is lead by Professor David Lewis. Within South Africa, he is an Honorary Associate Professor in the School of Clinical Medicine at the University of the Witwatersrand, Honorary Research Associate at the University of Cape Town (UCT) and an Adjunct Member of UCT’s Institute of Infectious Diseases and Molecular Medicine. In addition, he holds an Honorary Senior Lecturership at the London School of Hygiene and Tropical Medicine.

Professor Lewis has worked in the field of STIs since 1989 from both clinical and microbiological perspectives. He trained in STI and HIV/AIDS management in the UK and, until his move to South Africa in November 2004, held the position of Consultant Physician in Genitourinary and HIV Medicine at Guy's and St. Thomas' Hospitals NHS Trust in London.

His MSc research involved antimicrobial susceptibility testing and typing of gonococcal isolates. His PhD research, undertaken at Imperial College (London) and the University of Texas Southwestern Medical Center (Dallas), was funded through a Wellcome Trust Tropical Medicine Fellowship and focused on the pathogenesis of Haemophilus ducreyi infection.

In November 2005, Professor Lewis was appointed Regional Director for Africa for the International Union against Sexually Transmitted Infections (IUSTI). IUSTI is on the roster of the United Nations Economic and Social Council and is an Official Non-Government Organisation in Consultative Status with the World Health Organisation.

In September 2007, Professor Lewis was elected onto the International Executive Committee of the International Society for STD Research (ISSTDR). Professor Lewis also offers technical support to the World Health Organization (WHO) as a temporary advisor at WHO consultative groups and workshops addressing STI issues, particularly in Africa. In addition, he is Assistant Editor for the leading international STI journal 'Sexually Transmitted Infections' and is a joint editor for 'Sexual Health'.

A/Professor David Lewis MBBS, FRCP(UK), DTM&H, BA, MSc, PhD, Head of Department

Aulette Goliath, Department Secretary
Mikey Guness BSc (Hons), Research Manager
Elvis Baloyi, Driver

Laboratory Team:
Frans Radebe NH Dip Med Tech (Virology) MSc (Med), Laboratory Manager
Etienne Muller BMedSci BSc (Hons) MSc (Med Virology) PhD, Senior Medical Scientist
(Vacant), Laboratory Supervisor
Lindy Scott Med Tech (Micro), Chief Medical Technologist
Ilze Venter MSc (Medical Virology), Medical Scientist
Precious Magooa BSc (Hons) (Micro), Medical Scientist
Sydney Khumalo, Research Assistant
David Mabaso, Research Assistant
Rodgers Chonco, Laboratory Cleaner

Clinical Surveillance and Data Entry Team:
Veerle Msimang Bio-engineer (Environmental Technology), Data manager
Stephina Tshelane NP (EH), B Tech (EH), Surveillance Officer
Sakhile Mhlongo BSc. Agric, Surveillance Officer
(Vacant), Laboratory (data) clerk

Clinical Team:
Ricky Ilunga B.Biomed.SC, MBBCh, Medical Officer
Martha Sello RN, RM, RCHN, RN ed.Bcur (UNISA), Clinical Nurse Manager
Charles Koeniate, Specialist Nurse
Tshepiso Mabena, Research Nurse
Moses Thwala, Research Nurse
Violet Chiloane, Research Nurse
Zodwa Mzaidume, Research Nurse
Ntombi Metsing, Research Nurse
Iris Atlee, Research Nurse
Gadifele Khasu, Research Nurse
Alex Vezi, HIV VCT Counsellor
Sipho Mbabela, HIV VCT Counsellor
Sana Mabogwane, HIV VCT Counsellor

CDC Project Team:
(Vacant) CDC Projects Coordinator
(Vacant) CDC Project Research Manager
(Vacant) CDC Project Research Manager
(Vacant) CDC Project Research Manager
Jabulani Ncayiyana, CDC Data manager
Nondumiso Sithole, CDC Administrative Clerk
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Project Updates

INTRODUCTION



2006 was a year of substantial success for the STI Reference Centre, with the successful completion of three major projects and an increase in PEPFAR funding for on-going research projects addressing public health concerns in the field of sexual health. The STI Reference Centre presented papers at international conferences and developed collaborative partnerships with local, national and international colleagues. The Centre also trained a number of personnel throughout the year, including data handlers and programme managers in the national surveillance programme, microbiology registrars, medical and dental students, laboratory and nursing staff both within and outside South Africa. Professor Lewis attended three WHO meetings as a technical advisor during 2006 to discuss rapid STI tests and STI syndromic management incorporation in medical and nursing student curricula in Africa.

Click on one of the subheading to go to that section under Project Updates:


Microbiological Surveillance for STIs



The STI Reference Centre continued to co-ordinate the national microbiological surveillance of sexually transmitted infections in South Africa, again supported through PEPFAR funding via the NICD:CDC co-operative agreement. The programme aims to monitor the syndromes of male urethritis, vaginal discharge and genital ulcer disease. The aetiologies of the syndromes, their local or regional epidemiology and antimicrobial susceptibility patterns of Neisseria gonorrhoeae are being investigated.
Healt for All

Figure 1. The Salt River Clinic Surveillance team in Cape Town

Right to Left: Ms. Marie Slabbert, Sr. Amila Latif, Sr. Anita van Zijl, Prof. David Lewis
In the early part of 2006, surveillance was undertaken in the Northern Cape (Kimberley) by the STI Reference Centre. The CDC funds were also used to fund antimicrobial surveillance of gonococci in Kwa-Zulu Natal (Durban) and Mpumalanga with the support of the Microbiology Department, Nelson Mandela School of Medicine, University of KwaZulu Natal who undertook the testing of the specimens. In the last quarter of 2006, the STI Reference Centre employed two staff in the Western Cape and undertook both aetiological and antimicrobial resistance surveillance in Cape Town at Salt River Clinic (see Figure 1). The work was undertaken in collaboration with the Microbiology Department of Tygerburg Hospital, University of Stellenbosch. During 2006, the prevalence of ciprofloxacin resistance gonococci continued to increase (Figure 2) and a key meeting was held at the NDoH in October 2006 to further raise the issue of the failure of current first-line syndromic management protocols to cover gonococcal infections within the country. The STI Reference Centre undertook aetiological and antimicrobial resistance surveillance at Alexandra Health Centre from January to March 2007.



Figure 2. Ciprofloxacin resistance surveillance data for gonococci isolated from Johannesburg, Durban, Cape Town and Kimberley [2004 and 2005 Durban data were presented at the Sun City FIDSSA meeting, July 2005 and the 2006 Durban data were obtained with the financial support of PEPFAR funding administered through the NICD. The STI Reference Centre acknowledge the sharing of these data in NICD communiqués during 2006 by Professors Sturm and Moodley of the Microbiology Department, Nelson Mandela School of Medicine, University of KwaZulu Natal]
During 2006, the STI Reference Centre also assisted the National Departments of Health in Lesotho and Namibia with their national microbiological surveillance initiatives. Professor David Lewis and Mr. Frans Radebe undertook training of nurses and laboratory staff in Namibia in early 2007 as preparation for a planned aetiological and antimicrobial resistance survey.


Figure 3. Mr Obed Mohlamonyane training nurses about specimen collection in Maseru, Lesotho.
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CLINICAL SURVEILLANCE FOR STIs


The Gauteng Clinical STI Surveillance Programme is now in its 13th year and remains highly valued by the Provincial Department of Health in Gauteng. Throughout the year we received data from 21 sentinel sites, produced quarterly reports and an annual report for 2005. This programme remains the only clinical surveillance programme that produces timely and high quality data on STI syndrome caseload in South Africa and prides itself on rapid dissemination of information to the Province. Gauteng Province have re-affirmed their commitment to seeing this surveillance programme continue in the years ahead, certainly until such time as data from the national clinical surveillance programme is reported in the form of timely quarterly and annual reports and demonstrates sustainability akin to the Gauteng surveillance programme.

A pilot SADC STI surveillance programme, funded by the UK Department for International Development through partnership with the Health Systems Trust, covering high transit/cross border sites in Botswana, Namibia, Lesotho and Swaziland was launched in late 2004 and came to an end in September 2006. The final data in relation to establishing enhanced clinical surveillance programmes in the four countries were presented in part by our staff at the SADC conference in Swaziland in September this year.
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Research Projects


STUDY TO ASSESS THE EFFECT OF ACYCLOVIR TREATMENT ON GENITAL ULCER HEALING IN MEN


This randomised placebo-control trial of acyclovir and its effect on GUD duration and HIV shedding, funded through the NICD:CDC co-operative agreement, came to a successful conclusion in December 2006 (Figure 4). The target of 600 participants was reached with a final recruitment number of 612 men.

The trial was conducted at Eloff Street clinic, Alexandra Health Centre, Folang Clinic in Pretoria and in the latter few months in the NHLS Braamfontein Occupational Health Department, where patients were referred from Esselen Street clinic in Hillbrow. Special thanks are due to the Reproductive Health and HIV Research Unit who assisted the STI Reference Centre reach the required target by the end of 2006 through enhanced recruitment of men with genital ulcers at the Esselen Street site.

We would also like to thank our colleagues in Regions 7 and 8 within Johannesburg City Health, and within Tswane Metro Health Department for assisting us with the successful completion of this study. The CDC Principal investigator, Dr Gabriela Paz-Bailey, and the CDC Study Statistician returned to the NICD in early 2007 to analyse the data. This is a very key study and the global STI community was very interested in the results which were released at the joint ISSTDR-IUSTI meeting in Seattle in August 2007.


Figure 4. Episodic Herpes Therapy Study Team

Right to Left: Zanele Jele, Sana Mabogwane, David Lewis (NICD PI), Violet Chiloane, Precious Magooa, Alex Vezi, Lindy Scott, David Pitsoane, Frans Radebe, Sipho Mbabela, Myron Wettrich (CDC-Pretoria), Dudu Ntuli, Aulette Goliath, Tiny Zwane, Gabriela Paz-Bailey (CDC PI)

HIV VCT AND STI SCREENING STUDIES IN CARLETONVILLE


The Centre’s 3 year expanded periodic presumptive therapy (PPT) study ended in February 2006. Following the preparations undertaken at the end of 2005, two new USAID-funded studies assessing the acceptability of HIV voluntary counselling and testing (VCT) and STI screening in both women at high risk (WAHR) and men living in the Carletonville area were successfully undertaken and completed. The HIV VCT counselling was provided by trained counsellors working in tents placed adjacent to the mobile clinic vans (Figures 5 and 6).

The STI Reference Centre employed the first VCT counsellors in the NHLS for this project. The STI Reference Centre teamed up with the Mothusimpilo Project to perform this research and benefited from the close working relationship built up over a number of years between the WAHR and the mobile van nurses (Figure 7).


Figure 5. Mothusimpilo Project Mobile Clinic for STI screening

Figure 6. Mock demonstration of HIV VCT being performed in tents erected next to the mobile clinics
At the end of 8 months, utilising three mobile vans for four days a week, a total of 1184 WAHR participated in the study; 1160 (98%) underwent screening for STIs and 984 (83%) took an HIV test. Of the 984 accepting VCT, 579 (59%) tested HIV antibody positive. In a similar manner, a smaller three month project using all male staff and just one mobile van for 4 days a week managed to enrol 309 men, of whom 303 (98%) agreed to STI screening and 262 (85%) agreed to take an HIV test (28% were HIV antibody positive). Those participants that were HIV seropositive had same day blood tests performed for subsequent CD4 count and HIV viral load and they were referred to local ARV/wellness sites with their results.


Figure 7. Carletonville VCT Study Team

Right to Left:Lydia Masimola, Frans Radebe, Priscilla Ncameni, Thando Mosiro, Sipho Mbabela, Alex Vezi, Veronica Nosi, Inge Zietsman, Xolani Siyasi, Zodwa Mzaidume, Gadifele Khasu, Cadwill Pillay, Iris Attlee

THE STI REFERENCE CENTRE’S STI CLINIC FOR MEN IN ALEXANDRA


During 2005, the STI Reference Centre established in collaboration with Region 7, a specialist men’s ‘drop-in’ STI service within 8th Avenue Primary Health Care clinic. This venture would not have been possible without the support and encouragement of Region 7’s Regional Health Manager and her team (Gloria Keetse and Zanele Mophosho) and the staff of 8th Avenue clinic, in particular Sr. Wendy Twalo and Sr. Reynolda Kgatuke. This clinic has continued to be popular among men in Alexandra and has enabled the STI Reference Centre and the NICD to make an important contribution to the health of our local community as well as providing a clinical research and surveillance site. A poster describing key findings from the first year’s clinic activities was presented at an international meeting by Mr. Obed Mohlamonyane, the STI Reference Centre nurse responsible for service provision.


Figure 8. Mr Obed Mohlamonyane discussing the men’s clinic with members of Alexandra’s community


Figure 9. Staff from the STI Reference Centre participated in the 2007 Sexual Health week events in Alexandra
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Other STIRC activities


REGIONAL DIRECTORSHIP FOR AFRICA, INTERNATIONAL UNION AGAINST STIS (IUSTI)


Professor Lewis was appointed Regional Director of the African Branch of IUSTI at the start of 2006. The African Region has been relatively inactive for a number of years and this opportunity for developing an STI network across Africa dovetails nicely with the strategic objectives of the NICD. Mrs Aulette Goliath from the Centre supported the work of IUSTI at the October 2006 IUSTI-Europe meeting, where she staffed the first IUSTI membership booth (Figure 10) and attended the IUSTI world EXCO meeting as an observer. IUSTI-Africa is now the fastest growing of IUSTI’s 5 global Regions. An IUSTI-Africa newsletter was established in July 2007. For more information, please e-mail e-mail: or go to www.iusti.org/regions/africa/default.htm


Figure 10. Mrs Aulette Goliath welcomes Dr Pierre Yassa (Zambia) to membership of IUSTI-Africa

STIRC book 3rd edition
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Conferences and Presentations

Mpumalanga Provincial Department of Health STI Seminar
Nelspruit, South Africa 13 February 2006


Lewis DA. STI syndromic management. (oral)


3rd Public Health Conference of the Pubic Health Association of Southern Africa
Johannesburg, South Africa 15-17 May 2006


Cheyip M. A pilot sentinel STI surveillance system for Botswana, Namibia, Lesotho and Swaziland. (poster)


British Association of Sexual Health and HIV Spring Meeting
Nottingham, UK 17-19 May 2006


Lewis DA. Lessons from South Africa. (oral)


14th Congress of the International Union against STIs - Asia Pacific Branch
Kuala Lumpur, Malaysia 27-30 July 2006


Lewis DA. The changing tide of STIs in South Africa. (oral)
Lewis DA. Double Trouble: STI-HIV interactions. (oral)


3rd APTIMA Users Meeting
Versailles, France 17-18 October 2006


Magooa P. Comparison of the Aptima Combo 2 and Real Time PCR for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens (oral)


22nd Congress of the International Union against STIs - Europe Branch
Versailles, France 19-21 October 2006


Lewis DA. Controlling the HIV epidemic in South Africa: future challenges (oral)
Lewis DA. Does periodic presumptive therapy with azithromycin affect the prevalence of STIs and HIV in high risk women? (oral)
Cheyip M. Clinical surveillance of STIs in three population groups in a mining community in South Africa. (poster)
Pillay C. Introduction of voluntary counselling and testing to existing PPT services in the Carletonville mining area of South Africa (poster)
Mohlamonyane O. Unayo i-drop na? Establishment of a specialist men’s sexual health clinic in a South African Township. (poster)


Haemophilus ducreyi symposium, 17th Meeting of the International Society for STD Research and 10th World Congress of the International Society against STIs,
Seattle. July 29 – August 1, 2007


Lewis DA, Ronald A. The declining prevalence of H. ducreyi in previously endemic area: hypotheses and implications for syndromic management and clinical and basic research. (oral)


17th Meeting of the International Society for STD Research and 10th World Congress of the International Society against STIs, Seattle.
July 29 – August 1, 2007


Lewis DA, Cheyip M, Baepi M, Bolani M, Radebe F. Impact of new periodic presumptive therapy services on STI syndromes and infections in high risk women living within South African mining communities. (oral)
Lewis DA, Magooa P, Mhonto S, Mohlamonyane O, Black V. Comparison of a rotor gene-based real-time PCR and the Aptima Combo-2 assay for the diagnosis of gonococcal and chlamydial infection in male urine samples. (poster)
Lewis DA, Scott L, Slabbert M, Mkhonto S, van Zijl A, Ntuli D, du Plessis N, Wasserman E, Radebe F. Escalation in the prevalence of ciprofloxacin resistant gonorrhoea in men presenting with urethritis to public health facilities in two South African cities. (poster)
Muller E, Paz-Bailey G, Pillay C, Lewis DA. The aetiology of genital ulcer disease among men presenting at primary health care clinics in South Africa. (poster)
Müller EE, Mkhonto S, Mhlongo S, Zietsman I, Radebe F, Nyati F, Lewis DA. The aetiology of vaginal discharge, male urethritis and genital ulcer syndromes in Kimberley, South Africa. (poster)
Lewis DA, Cheyip M, Hussein F, Mndzebele S, Matumo N, Elgoni A. Establishment of enhanced clinical surveillance systems for sexually transmitted infections in Botswana and Swaziland. (poster)
Lewis DA, Tshelane S, Khanyile N, Pillay C. Surveillance of sexually transmitted infections in Gauteng Province, South Africa: 2000-2006. (poster)
Lewis DA, Pillay C, Mohlamonyane O, Mbabela S, Vezi A, Mzaidume Z, Radebe F. Opening Pandora’s box: exposing the burden of HIV and sexually transmitted infections among men residing in informal settlements near Carletonville, South Africa. (poster)
Radebe F, Black V, Myers M, Pillay C, Lewis DA. A study to determine the aetiology of symptomatic and asymptomatic urethritis in an inner-city region of Johannesburg, South Africa. (poster)
Radebe F, Odinsen O, Parker D, Lewis DA. Early detection of HIV-1 specific lymphocyte derived antibodies in a high risk population. (poster)
Lewis DA. Challenges for Africa: antibiotic resistance, changing STI aetiologies and devastation by HIV. (Symposium presentation)
Paz Bailey G, Sternberg M, Puren A, Pillay C, Ballard R, Delany S, Hawkes S, Nwanyanwu O, Lewis DA. Impact of episodic therapy on genital ulcer duration and HIV shedding from herpetic ulcers among men in South Africa. (Late-breaker oral presentation).


Australasian Sexual Health Conference 2007, Gold Coast, Australia.
8-10 October 2007


Lewis DA. HIV and women: the African Experience. (oral)
Lewis DA. Measuring trends in STI syndrome aetiologies and antibiotic resistance patterns: the South African experience. (oral)


2007 FIDSSA 2nd Joint Congress, Spier, Cape Town.
28-31 October 2007


Lewis DA, Mhlongo S, Cheyip M, Baepi M, Bolani M, Mzaidume Z, Mohlamonyane O, Radebe F. All that glitters is not gold: the prevalence of STIs and HIV among women at high risk and local men on the West Rand. (oral)
Tshelane S, Mhlongo S, Lewis DA. Surveillance of sexually transmitted infections in Gauteng Province, South Africa: 2000-2006. (poster)
Scott L, Khumalo S, Mhlongo S, Radebe F, Lewis DA. Evaluation of the Syphilis Total Antibodies (TA) EIA II test for the detection of treponemal antibodies. (poster)

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STI Links

Related STI Links


HAST (National Department of Health) HAST
IUSTI (The International Union against Sexually Transmitted Infections) IUSTI
ISSTDR (The International Society for STD Research) ISSTDR
RHRU (Reproductive Health and HIV Research Unit) RHRU
FIDSSA (Federation of Infectious Diseases Societies of South Africa) FIDSSA
BASHH (British Association for Sexual Health and HIV) BASHH


STI Guidelines


World Health Organization (WHO) Guidelines for the Management of Sexually Transmitted Infections
Centers for Disease Control and Prevention (CDC) USA Sexually Transmitted Diseases Treatment Guidelines
British Association for Sexual Health and HIV (BASHH) Clinical Effectiveness Guidelines
International Union against Sexually Transmitted Infections (IUSTI) European STD Guidelines


STI Journals


Sexually Transmitted Infections
Sexually Transmitted Diseases
International Journal of STD & AIDS
Sexual Health
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