17. Sexually Transmitted Infections

Abstract

The epidemiology of sexually transmitted infections (STIs) has been changing in developing countries as a result of case management approaches and behavioral changes in response to the HIV epidemic; nevertheless, the burden of morbidity and mortality remains high.

While both bacterial and viral STIs are widespread, incidence of bacterial STIs (for example, chancroid syphilis, gonorrhea, chlamydial infection, and Trichomonas vaginalis) has declined, while that of viral STIs (for example, herpes simplex, hepatitis B, and human T cell lymphotropic virus) has increased. Delayed diagnosis and treatment lead to high rates of complications such as adverse pregnancy outcomes, neonatal defects, liver problems, and central nervous system disease.

Sexual behaviors that contribute to the transmission of sexually transmitted diseases are influenced by many factors. Rising levels of inequality among poor populations, greater mobility, and a larger percentage of people living in postconflict settings have increased multipartner sexual activity and the rate of spread.

A novel approach to STI intervention was developed for use in Madagascar in a pilot study, Priorities for Local AIDS Control Effort (PLACE). This approach identified urban sites where more sexually active adults gathered. Information and condoms were then distributed at these locations, and thus the most sexually active people were targeted in a cost–effective manner. In addition to PLACE methods, sex education in school curricula can lay the foundation for strong STI prevention and treatment campaigns.

We lack data on why STI treatment and other health services vary so much in efficiency and effectiveness. By studying the determinants of this variation, we would learn how to deliver high–quality STI service most effectively.