Feeling completely fine is no guarantee that you are STI-free. Millions carry silent infections like chlamydia, gonorrhoea, and HPV without symptoms, driving hidden transmission and serious long-term health risks.
This World Sexual and Reproductive Health Month, medical experts are confronting persistent stigmas through four core actions: talk, test, protect, and empower.
True sexual well-being requires breaking the silence, debunking relationship myths, and treating routine testing as essential healthcare.
It means having total control over one's body and choices, supported by accurate information, protection against sexually transmitted infections (STIs), access to contraception and an understanding of consent.
Yet, despite modern medical advances, shame and misinformation continue to stand in the way.
Can you have an STI without symptoms?
The belief that an infection always presents physical symptoms remains a dangerous misconception. Across South Africa, millions carry infections without knowing it, driving a high rate of silent transmission.
"This is one of our biggest challenges: a large proportion of STIs are asymptomatic," explains Dr Ntombifikile Mtshali, CEO of Shout-It-Now, a South African non-profit organisation providing free, youth-centred sexual and reproductive health services via mobile clinics and digital platforms.
"Chlamydia and gonorrhoea are particularly important examples. Women can carry either infection without discharge, pain, or any obvious indication that something is wrong. Human Papillomavirus (HPV) very commonly causes no symptoms, herpes can be transmitted without visible sores, and syphilis can enter a latent phase with no symptoms at all."
Mtshali emphasises that "I feel fine" is not synonymous with "I do not have an STI". Left untreated, silent infections in women can progress to severe long-term complications, including pelvic inflammatory disease, tubal scarring, ectopic pregnancy and infertility.
Epidemiological data underscore the scale of the issue. Dr Mark Faesen, a specialist gynaecologist at the Clinical Health Research Unit at the University of Witwatersrand (Wits), highlights the current landscape across South Africa:
HPV: Holds the highest overall prevalence and is strongly linked to cervical, vulvar, vaginal, anal, penile and oropharyngeal cancers.
HIV: Maintains the heaviest chronic disease burden with approximately 8 million South Africans living with the virus, though overall incidence has declined compared to previous decades.
Chlamydia and Gonorrhoea: Chlamydia remains the leading asymptomatic bacterial STI, particularly among adolescent girls and young women. Meanwhile, Neisseria gonorrhoeae dominates symptomatic male urethritis, identified in over 80% of cases in current sentinel surveillance.
Syphilis: Shows a concerning epidemiological trajectory, with rising antenatal prevalence and congenital syphilis rates remaining well above elimination targets.
Does a positive STI test prove infidelity?
A positive STI result often triggers intense relationship conflict due to the assumption that it proves recent unfaithfulness. Medical experts stress that this assumption is scientifically false.
"A positive STI test does not automatically mean that a partner has been unfaithful," says Faesen. "Many STIs can remain silent for months or even years. A person may have acquired an infection before entering their current relationship without ever knowing it."
Mtshali concurs, noting the importance of distinguishing between an infection being medically latent and simply asymptomatic. Viral infections like HSV, HPV, HIV, and the latent stage of syphilis can remain hidden long before detection. Therefore, a new diagnosis cannot pinpoint when or from whom an infection was acquired.
Beyond relationship fallacies, basic transmission myths persist.
Environmental contact, such as sitting on a public toilet seat, presents no realistic risk for transmitting STIs like chlamydia, gonorrhoea, syphilis, HIV or HPV. Similarly, hygiene practices after sex do not neutralise an exposure.
"Washing after sex does not 'wash away' an infection," states Mtshali. "The message must shift from cleaning yourself afterwards to protecting yourself before and during exposure."
Dr Anna-Ursula Happel, a senior research officer at the University of Cape Town’s Institute of Infectious Disease and Molecular Medicine, adds, "By the time someone washes, pathogens may already have attached to or entered susceptible tissues of the genital tract.
"Washing also cannot reliably remove all microorganisms from these sites. Effective prevention strategies therefore include consistent condom use, vaccination when available (i.e. against HPV), or pre-exposure prophylaxis for HIV where appropriate."
Can oral sex transmit STIs?
Misconceptions regarding oral sex are equally common.
Because oral sex carries no risk of unintended pregnancy, it is frequently miscategorised as risk-free. However, pregnancy risk and STI risk are distinct. Gonorrhoea, syphilis, herpes, HPV, and chlamydia are easily transmitted via oral sex.
Gonorrhoea can infect the pharynx completely without symptoms, while oral HPV transmission is now recognised as a primary driver of oropharyngeal cancers.
"Sex got defined as penetration: in most sex education, medical intake forms, and everyday language, sex implicitly means vaginal and/or anal intercourse. Oral sex often isn't even counted as having sex by many people, and if it's not categorised as sex, it doesn't get slotted into safe sex conversations.
"HPV deserves special mention. It's often left out of STI conversations altogether because, until relatively recently, it wasn't framed as an STI in public consciousness. It was framed as a cervical cancer issue, tied to Pap smears and the HPV vaccine for girls.
"That women's reproductive health framing meant its oral and throat transmission route (now a leading cause of oropharyngeal cancers) got very little public attention," says Faesen.
Infection, not disease: The power of language
The global medical community's transition from "STD" (Sexually Transmitted Disease) to "STI" represents an intentional effort to improve clinical accuracy and reduce social shame.
As Faesen points out, the Centers for Disease Control and Prevention (CDC) distinguishes between an infection (the presence of an infectious organism) and a disease (when that infection progresses to a clinical state of illness). Because the majority of STIs cause zero symptoms, using the term "disease" is often medically inaccurate.
Language also carries socio-emotional weight. "Calling something an infection allows us to speak about it as what it is: a health condition that can happen to any sexually active person, rather than a moral judgement," notes Mtshali.
"We need to normalise saying: 'I had sex, I am taking care of my health, so I am testing'."
Integrated healthcare and the STI-HIV connection
Addressing STIs is also essential for HIV control. An untreated STI can increase a person's susceptibility to acquiring or transmitting HIV by 1.5 to 3-fold, particularly when active genital ulcers are present.
"Regardless of whether a person has symptoms or not, untreated STIs can substantially increase both HIV acquisition and transmission risk. For example, Herpes Simplex Virus type 2 (HSV-2) infection is thought to triple HIV acquisition risk. STIs like syphilis, gonorrhoea and HSV can cause inflammation or ulceration, making HIV entry easier.
"STIs also attract immune cells to the genital tract, thereby providing more target cells for HIV. For people living with HIV, concurrent STIs may increase genital HIV shedding, potentially increasing the likelihood of transmission if HIV is not fully suppressed by treatment," advises Happel.
In South Africa, integrative care also means bridging traditional practices and Western medicine. Rather than framing the two as opposing forces, health experts advocate for collaborative care pathways.
"Traditional healers can be valuable partners in STI control in South Africa precisely because they may be the first point of contact for people who would otherwise delay or avoid clinic care.
"The safest model is therefore not to ask patients to choose between traditional and Western medicine, but to establish a rapid referral pathway in which suspected STIs receive evidence-based diagnosis and antimicrobial treatment promptly, while traditional practitioners continue culturally appropriate counselling and supportive care," shares Faesen.
Where to get STI testing in South Africa
For anyone who suspects an STI exposure or is due for routine screening, clear pathways exist across both public and private health sectors in South Africa.
Public sector: Services are free at local primary healthcare clinics and community health centers. Public facilities predominantly utilise a syndromic approach, where healthcare providers assess reported symptoms and immediately initiate treatment covering the most common causes. Patients should actively request HIV and syphilis testing during these visits and follow treatment courses entirely.
Private sector: Consultations with GPs, gynaecologists or sexual health specialists offer direct access to pathogen-specific laboratory diagnostics, such as molecular urine or swab tests for chlamydia and gonorrhoea.
It is vital to disclose the specific nature of the exposure (oral, vaginal or anal), as standard genital tests will miss throat or rectal infections.
Critically, clinicians warn against self-medicating with leftover antibiotics or unregulated remedies. Antimicrobial resistance in Neisseria gonorrhoeae is a growing global and local concern; targeted, correct antibiotic regimens are essential to prevent treatment failures.
When a positive test occurs, informing partners can induce significant anxiety, but changing the dialogue from blame to mutual health protection simplifies the process.
"Tell them what they need to know without turning the conversation into a trial," advises Mtshali. "Instead of saying 'You gave me something,' frame it as 'One of us has tested positive, which means both of us need to look after our health.'
"If there is any fear of violence or retaliation, face-to-face conversations are not mandatory; patients can ask healthcare providers about safe, assisted partner notification."
World Sexual and Reproductive Health Month is a reminder that routine testing, accurate information, and honest communication are simply normal, everyday parts of taking care of yourself.
alyssia.birjalal@nationalmg.co.za