STI Research

There is a high burden of sexually transmitted infections (STIs) in South Africa, especially Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Treponema pallidum, the causative agent of syphilis. Untreated STIs are associated with genital tract morbidity, pelvic inflammatory disease, and long-term complications such as tubal-factor infertility, ectopic pregnancy, and adverse pregnancy outcomes. Furthermore, risk of HIV transmission and acquisition is increased without effective HIV PrEP and/or antiretroviral therapy (ART). Last, emergence of antimicrobial resistance (AMR), especially in N. gonorrhoeae, is a major global concern. We work with various national and international partners and donors in these projects.

Over the past years, FPD has established a STI research portfolio that is world-class and in line with South Africa’s National Strategic Plan for Sexually Transmitted Infections 2023-2028 Read More and the WHO Global Health Sector strategy for sexually transmitted infections 2022 – 2030 . The research team is valued among the key opinion leaders in this field and participates in various technical advisory groups and technical working groups of the World Health Organization, the National Department of Health, and other national and international clinical and professional bodies.

The FPD team in Buffalo City has established STI research facilities at five primary healthcare facilities (Duncan Village Day Hospital; Empilweni Gompo CHC; Grey Gateway clinic; Ndevana PHC and Nontyatyambo CHC). This includes well-trained clinical staff, point-of-care STI diagnostic test resources, ultrasound capacity and data collection and storage infrastructure. The facilities are supported by a local private laboratory for N. gonorrhoeae culture and syphilis serological testing, and the Department of Medical Microbiology at the University of Pretoria for in-depth microbiological evaluations of specimens including AMR detection and molecular epidemiological analysis. Vaginal microbiome work is done in collaboration with the Division of Medical Microbiology at the University of Cape Town.

The Philani Ndiphile project aims to recruit 2500 pregnant women in an implementation-effectiveness trial of the impact of three STI diagnostic approaches on pregnancy and birth outcomes. Also, comprehensive analysis of genital tract infections and microbiome composition is conducted in a separate prospective cohort study. Other evaluations in this project include a cost-effectiveness analysis of STI diagnostic testing in pregnancy, implementation science evaluation of STI diagnostic testing using the RE-AIM framework, and a project of Trichomonas vaginalis culture and antimicrobial susceptibility testing.

The Live Well project aims to evaluate a novel lateral flow assay (NG LFA) for point-of-care detection of N. gonorrhoeae in 400 symptomatic and 900 asymptomatic individuals at primary healthcare facilities. Performance is compared with Xpert® CT/NG assay as reference test. Discordant results are further analysed for other Neisseria species at the University of Pretoria. Feasibility, usability, and acceptability analyses are also conducted to provide guidance to potential implementation strategies.

Project Hamboyijonga aims to recruit up to 500 individuals with genital ulcer or presumptive condylomata lata for diagnostic evaluation. Syphilis rapid diagnostic testing and laboratory serological analysis are performed, and PCR is performed of swabs collected from the lesions to establish aetiology. Further genomic analysis of Treponema pallidum DNA obtained of lesions from patients with syphilis is performed to better understand genetic relatedness and epidemic spread, antimicrobial resistance, and putative vaccine targets.

Our Research Staff

Mrs Mandisa Mdingi

Research Manager

Ms Zimkhitha Mphathi

Senior project coordinator

Current projects

Clinical study of STI screening to prevent adverse pregnant and birth outcomes

Start Date : 2022-01-01 End Date : 2024-12-31

Donors : National Institutes of Health (grant 5R01AI149339 and the Swiss National Science Foundation (project 197831).

Novel point-of-care test for Neisseria gonorrhoeae infection in syndromic management settings

Start Date : 2021-10-31 End Date : 2024-06-30

Donors : The Global AMR Innovation Fund (GAMREF) through FIND

Genomic epidemiology of Treponema pallidum in South Africa

Start Date : 2023-01-31 End Date : 2024-12-31

Donors : Open Philanthrop

Past projects

Molecular epidemiology and antimicrobial resistance of Neisseria gonorrhoeae isolates in East London

Start Date : 2022-01-01 End Date : 2023-03-31

Donors : SA MRC through GARDP.

Screening and treating pregnant women for STIs.

Start Date : 2016-01-01 End Date : 2018-12-31

Donors : Eunice Kennedy Shriver Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) under award number: R21HD084274.


Peters RPH, McIntyre JA, Garrett N, Brink AJ, Celum CL, Bekker LG. Doxycycline post-exposure prophylaxis for sexually transmitted infections in South Africa. S Afr J HIV Med 2023; In press. Access

Mensah E, Fourie PB, Peters RPH. Antimicrobial effects of Medicines for Malaria Venture Pathogen Box compounds on strains of Neisseria gonorrhoeae. Antimicrob Agents Chemother 2023; In press. Access

Peters RPH, Jung H, Mitchev N, Mdingi MM, Gigi RMS, Shroufi A, Martinez FP, Bamford C. Antimicrobial resistance and molecular typing of Neisseria gonorrhoeae isolates from the Eastern cape province in South Africa. Sex Transm Dis 2023; accepted for publication. Access

Peters RPH, Mdingi M, Jung H, Mukomana F, Gigi RMS, Medina-Marino A, Klausner JD. Low prevalence of Schistosoma haematobium infection in pregnant women in Buffalo City district. S Afr J Infect Dis 2023; 38(1): 521. Access

De Vos L, Daniels J, Gebengu A, Mazzola L, Gleeson B, Piton J, Mdingi M, Gigi R, Ferreyra C, Klausner JD. Usability of a novel lateral flow assay for the point-of-care detection of Neisseria gonorrhoeae: a qualitative time-series assessment among healthcare workers in South Africa. PLoS One 2023; 18(6): e0286666.

Peters RPH, Garrett N. New guidance on managing sexually transmitted infections from the Southern African HIV Clinicians Society. HIV Nursing Matters 2023; 16(1): 34-38.

Babalola CM, Peters RPH, Mukomana F, Mdingi M, Gigi RMS, Muzny CA, Taylor CM, Medina-Marino A, Klausner JD. A call to standardize the definition and method of assessing women for vaginal discharge syndrome in pregnancy. Open Forum Infect Dis 2023; 10(4): ofad157.

Gigi RMS, Buitrago-Garcia D, Taghavi K, Dunaiski CM, van de Wijgert JHHM, Peters RPH, Low N. Vulvovaginal yeast infections during pregnancy and perinatal outcomes: systematic review and meta-analysis. BMC Womens Health 2023; 23(1): 116.

Dorrell P, Pillay Y, Maithufi R, Pinini Z, Chidarikire T, Stamper N, Frank D, Peters RPH. Impact of the first COVID-19 lockdown on male urethritis syndrome services in South Africa. Sex Transm Infect 2023; 99(3): 200-202.

Mdingi MM, Peters RPH, Gigi R, Babalola C, Taylor CM, Muzny CA, Low N, Medina-Marino A, Klausner JD. Same-day treatment following point-of-care sexually transmitted infection testing in different healthcare settings in South Africa. Clin Infect Dis 2023; 76(9): 1699-1700.

Peters RPH, Garrett N, Chandiwana N, Kularatne R, Brink AJ, Cohen K, Gill K, Chidarikire T, Wattrus C, Nel JS, Moose MYS, Bekker LG. Southern African HIV Clinicians Society 2022 Guideline for the management of sexually transmitted infections: moving towards best practice. S Afr J HIV Med 2022; 23(1): 1450.

Verweij SP, Peters RPH, Catsburg A, de Vries HJC, Ouburg S, Morre SA. Genetic variation in the MBL2 gene is associated with Chlamydia trachomatis infection and host humoral response to Chlamydia trachomatis infection. Int J Mol Sci 2022; 23(16): 9292.

Dunaiski CM, Kock MM, Jung H, Peters RPH. Importance of Candida infection and fluconazole resistance in women with vaginal discharge syndrome in Namibia. Antimicrob Resist Infect Control 2022; 11(1): 104.

Nyemba DC, Peters RPH, Medina-Marino A, Klausner JD, Ngwepe P, Myer L, Johnson LF, Joseph Davey DL. Impact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africa. BMC Pregnancy Childbirth 2022; 22: 194.

Medina-Marino A, Cleary S, Muzny CA, Taylor C, Tamhane A, Ngwepe P, Bezuidenhout C, Facente SN, Mlisana K, Peters RPH, Klausner JD. Sexually transmitted infection screening to prevent adverse birth and newborn outcomes: study protocol for a randomized-controlled hybrid-effectiveness trial. Trials 2022; 23: 441.

Peters RPH, Chico M, Rowley J, Low N. Estimating the global burden of sexually transmitted infections. Lancet Infect Dis 2022; 22(8): 1112-1113.

Peters RP, Feucht UD, de Vos L, Ngwepe P, McIntyre JA, Klausner JD, Medina-Marino A. Mother-to-child transmission of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in HIV-infected women in South Africa. Int J STD AIDS 2021; 32(9): 799-805.

Peters RPH, Klausner JD, de Vos L, Feucht UD, Medina-Marino A. Aetiological testing compared with syndromic management for sexually transmitted infections in HIV-infected pregnant women in South Africa: a non-randomised prospective cohort study. BJOG 2021; 128(8); 1335-42.

Juliana NCA, Peters RPH, Al-Nasiry S, Budding AE, Morré SA, Ambrosino E, et al. Composition of the vaginal microbiota during pregnancy in women living in sub-Saharan Africa: a PRISMA-compliant review. BMC Pregnancy Childbirth 2021; 21(1) 596.

Peters RPH, Maduna L, Kock MM, McIntyre JA, Klausner JD, Medina-Marino A. Single dose azithromycin for genital LGV biovar Chlamydia trachomatis infection in HIV-infected women in South Africa: an observational study. Sex Transm Dis 2021; 48(2): e15-e17.

Peters RPH, Jung HS, Muller EE, Kock MM, Myer L, Klausner LD, Joseph Davey D. Lack of macrolide resistance in Mycoplasma genitalium infections in a cohort of women in South Africa. Sex Transm Infect 2021; Online ahead of print.

Laumen JGE, van Alphen LB, Maduna LD, Hoffman CM, Klausner JD, Medina-Marino A, Kock MM, Peters RPH. Molecular epidemiological analysis of Mycoplasma genitalium shows low prevalence of azithromycin resistance and a well-established epidemic in South Africa. Sex Transm Infect 2021; 97(2): 152-156.

Peters RPH, Joseph Davey DL, Bekker LG, Myer L, Medina-Marino A, Klausner JD. Antiretroviral therapy, sexually transmitted infections, and pregnancy outcomes in South Africa. Clin Infect Dis 2021; 73(3): e851-2.

Juliana NCA, Suiters MJM, Al-Nasiry S, Morré SA, Peters RPH, Ambrosino E. The association between vaginal microbiota dysbiosis, bacterial vaginosis, anaerobic vaginitis, and adverse pregnancy outcomes of women living in sub-Saharan Africa: a systematic review. Front Public Health 2020; 8: 567885.

Nyemba DC, Medina-Marino A, Peters RPH, Klausner JD, Ngwepe P, Myer L, Johnson LF, Joseph Davey D. Prevalence, incidence, and associated risk factors of STIs during pregnancy in South Africa. Sex Transm Infect 2020; Online ahead of print.

Maduna LD, Kock MM, van der Veer BMJW, Radebe O, McIntyre J, van Alphen LB, Peters RPH. Antimicrobial resistance of Neisseria gonorrhoeae isolates from high-risk men in Johannesburg, South Africa. Antimicrob Agents Chemother 2020; 64 (11): e00906-20.

Medina-Marino A, Mudau M, Kojima N, Peters RPH, Feucht UD, de Vos L, Olivier D, Muzny CA, McIntyre JA, Klausner JD. Persistent Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis positivity after treatment among human immunodeficiency virus-infected pregnant women, South Africa. Int J STD AIDS 2020; 31: 294-302.

Smullin C, Green H, Peters RPH, Nyemba D, Qayiya Y, Myer L, Klausner JD, Davey DJ. Prevalence and incidence of Mycoplasma genitalium in HIV-infected and -uninfected pregnant women in Cape Town, South Africa. Sex Transm Infect 2020; 96(7): 501-508.

Grant JS, Chico RM, Lee ACC, Low N, Medina-Marino A, Molina RL, Morroni C, Ramogola-Masire D, Stafylis C, Tang W, Vallely AJ, Wynn A, Yeganeh N, Klausner JD. Sexually transmitted infections in pregnancy: a narrative review of the global research gaps, challenges, and opportunities. Sex Transm Dis 2020; 47(12): 779-789.

Burke HM, Chen M, Murray K, Bezuidenhout C, Ngwepe P, Bernholc A, Medina-Marino A. The effects of the integration on the prevalence of sexually transmitted infections and saving behaviours among adolescents: a full-factorial randomized controlled trial in South Africa. BMJ Global Health 2020; 5(4): e002029.

Medina-Marino A, Glockner K, Grew E, de Vos L, Olivier D, Klausner J, Daniels J. The role of trust and health literacy in nurse-delivered point-of-care STI testing for pregnant women living with HIV, Tshwane District, South Africa. BMC Public Health 2020; 20(1): 577.

Daniels J, de Vos L, Mogos W, Olivier D, Shamu S, Mudau M, Klausner J, Medina-Marino A. Factors influencing sexually transmitted infection disclosure to male partners by HIV-positive pregnant women in Pretoria townships, South Africa: a qualitative study. Sex Health 2019; 16(3): 274-281.

Maduna LD, Kock MM, Medina-Marino A, Klausner JD, Peters RPH. Impact of specimen storage temperature and time on the implementation of GeneXpert® testing for sexually transmitted infections in resource-constraint settings. J Microbiol Methods 2019; 165: 105719.

Joseph Davey D, Peters RPH, Kojima N, Mudau M, de Vos L, Olivier D, McIntyre JA, Klausner JD, Medina-Marino A. Sexual behaviors of human immunodeficiency virus-infected pregnant women and factors associated with sexually transmitted infection in South Africa. Sex Transm Dis 2018; 45(11): 754-761.

Morikawa E, Mudau M, Olivier D, de Vos L, Joseph Davey D, Price C, McIntyre JA, Peters RPH, Klausner JD, Medina-Marino A. Acceptability and feasibility of integrating point-of-care diagnostic testing of sexually transmitted infections into a South African antenatal care program for HIV-infected women. Infect Dis Obstet Gynecol 2018; 2018: 3946862.

Shannon CL, Bristow C, Hoff N, Wynn A, Nguyen M, Medina-Marino A, Cabeza J, Rimoin A, Klausner JD. Acceptability and feasibility of rapid chlamydial, gonococcal and trichomonal screening in 6 low- to middle-income countries. Sex Transm Dis 2018; 45(10): 673-676.

Price CM, Peters RPH, Steyn J, Mudau M, Olivier D, de Vos L, Morikawa E, Kock MM, Klausner JD, Medina-Marino A. Prevalence and detection of Trichomonas vaginalis in HIV-infected pregnant women. Sex Transm Dis 2018; 45(5): 332-336.