Advances in control of sexually transmitted diseases in developing countries

Abstract

Sexually transmitted diseases (STDs) impose an enormous burden of morbidity and mortality in many developing countries, both directly through their impact on reproductive and child health,’ and indirectly through their role in facilitating the sexual transmission of HIV infection.’ It has been estimated that in urban populations in sub-Saharan Africa, for example, STDs are responsible for some 17% of the total burden of disease in women of reproductive age.’ Yet it is only in recent years that these diseases have been accorded any priority by national ministries of health or by the international community. The increased interest in STD control in developing countries is largely a result of the HIV epidemic. Reports of an association between the “classic” STDs and HIV infectior+ have now been supplemented by virological studies showing that intercurrent STDs increase concentrations of HIV in genital secretions@ (see also p ~1115); but more importantly, it has been shown that improved clinical services for STDs can significantly reduce the incidence of HIV infection in developing countries, and that this can be achieved by lowtechnology, sustainable, and highly cost-effective programmes.“LIL