A burning sensation. An itch that won’t go away. A rash. Yellow or brown or white discharge.
For many teenage girls and young women, these are things they don’t talk about. They’re symptoms to hide — from friends, partners, parents and even health-care providers.
That’s what researchers at the SA Medical Research Council found when they talked to nearly 5,000 girls and young women aged 15 to 24 across the country about sexually transmitted infections (STIs) and vaginal infections, said Zoe Duby, a senior specialist scientist and socio-behavioural researcher at the council
“SA has one of the highest rates of STIs in the world, with adolescent girls and young women more likely to have STIs than older women and boys and men of the same age,” said Duby. “Yet fewer than one in five of the girls spoken with said they had ever been diagnosed with an STI such as chlamydia, gonorrhoea or syphilis by a health professional, even though many said they had at least one symptom of either an STI or vaginal infection, such as thrush or bacterial vaginosis in the previous year,” said Duby.
Bacterial vaginosis happens when the normal balance of bacteria in the vagina gets disrupted, and common signs include a thin, grey or white vaginal discharge, a strong fishy smell, especially after sex, or mild itching or burning.
The study, published in the International Journal of Sexual Health earlier this year, found that shame, embarrassment and misunderstanding affect how young women understand and deal with STIs and other infections.
Although one 2022 study estimated that one in four women in SA have a curable, bacterial STI (which, unlike viral STIs such as HIV or human papillomavirus (HPV) can be treated), a quarter of the girls and young women spoken with in the new study chose not to answer the question about STI symptoms at all.
“The inability to talk about these infections can delay care, with missed opportunities to prevent bigger health problems later,” said Duby. “Leaving STIs untreated can have serious long-term effects like infertility, cancers, pregnancy complications and a higher chance of HIV infection.”
What the study revealed
In the survey, participants were asked about the following symptoms: itching, lumps, warts, rashes, redness, unusual smell from a yellow, brown or white discharge, and pain or a burning feeling when urinating or having sex.
Genital itching — which can be a sign of bacterial vaginosis, human papillomavirus or chlamydia — was the most commonly reported, with about two out of 10 saying they had experienced those symptoms in the past year.
“Other commonly reported symptoms included an unusual smell from a yellow, brown or white discharge, which can be experienced when you have chlamydia, gonorrhoea or bacterial vaginosis; pain or a burning feeling when urinating or having sex, which happens when you have chlamydia, gonorrhoea or thrush; warts, rashes, bumps or lumps due to HPV; or redness from thrush,” said Duby.
But most STIs are asymptomatic in women, which means that one can be infected without showing any signs.
Duby said that while vaginal infections such as thrush and bacterial vaginosis are not classified as STIs, they can be transmitted through sexual contact but can also be caused by an imbalance of normal bacteria in the vagina due to using antibiotics, hormonal changes or wearing damp, tight clothing.
“In many SA communities the vagina is wrapped in silence, indirect language and shame, with periods and vaginal fluids spoken about as dirty, shameful and disgusting rather than as normal bodily processes. That stigma does more than police our language: it can change how women and girls seek care, talk about their bodies and even understand what ‘clean’ and ‘healthy’ mean,” said Duby.
Families help, but silence remains
When 68 of the participants were interviewed in more detail, some young women said they trusted family members enough to disclose symptoms.
“While mothers, grannies and older sisters were important sources of advice, those conversations were often limited by embarrassment, moral judgment or a broader reluctance to talk openly about sex,” said Duby.
Others said they would rather stay silent than risk being blamed or labelled. Conversations with friends also played a big role, but the information passed around was often incomplete or wrong.
Schools are teaching, but not enough
School was the most common place where participants said they learnt about STIs, usually through life orientation classes.
“That matters, because it shows schools are one of the few spaces where sexual health information is already reaching young people widely,” said Duby. “But the knowledge was uneven. Some participants could clearly describe symptoms, transmission and treatment. Others confused STIs with other vaginal infections or held myths about how infections spread.”
Many girls said that they only ever received information about HIV and never learnt about other STIs and genital infections.
“That points to a bigger problem: girls are getting snippets of information, not the kind of accurate, confidence-building education that helps them act early, seek care without shame, and look after their long-term health,” said Duby.
Clinics are still not enough
Over half of the girls and young women told the interviewers that if they thought they had an infection they would go to a clinic or hospital to be checked. But girls aged under 18 were far less likely to go to a clinic than older girls, with only one in three under 18s saying they would seek care at a health facility, said Duby.
“Even though girls said they would try and get help, they said that they feared being judged, exposed or treated badly at clinics, which meant that some preferred pharmacies or private doctors or tried to find self-treatments on the internet instead of using public health services,” she said.
One of the main things stopping girls from seeking help for STIs is their fear of judgment by health-care workers. They are scared that admitting they have an STI will lead to finger-pointing, with health-care providers scolding them for being sexually active at their age and assuming that they sleep around if they require STI treatment.
What we need is all-in-one, youth-friendly sexual and reproductive health services...
— Scientist Zoe Duby
Why this matters
“While HIV prevention receives consistent attention in the public health, funding and education agendas, STIs remain under-addressed despite the high rates and the fact that having an STI increases someone’s chances of getting HIV through sex,” said Duby.
“What we need is all-in-one, youth-friendly sexual and reproductive health services that combine STI testing and treatment with contraception, HIV prevention, counselling and psychosocial support,” said Duby.
Bhekisisa Centre For Health Journalism
