Prevention of sexually transmitted diseases

Abstract

Sexually transmitted diseases (STDs) represent a serious and ongoing public health concern in the developing and developed world. In the United States between 10 million to 20 million new STD cases occur every year [1]. In 2002 this included 834555 cases of chlamydia a 6.5% increase in prevalence from 2001 [2]. Forty-five million people in the United States are infected with genital herpes and one million new cases occur every year [3]. Five million people worldwide became infected with HIV in 2003 [4] and over 281000 people in the United States are living with HIV [5]. Because most STDs are initially asymptomatic and several are incurable the best hope for decreasing the personal and social costs of these infections is prevention. A National Institute of Medicine report in 1997 recognized that “although the barriers to STD prevention are formidable STDs can be prevented” but lamented the lack of an effective national system for STD prevention [6]. It is debatable as to how much progress has been made over the last 7 years. The current Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines state “The prevention and control of STDs is based on the following five major concepts: a) education and counseling of persons at risk on ways to adopt safer sexual behavior; b) identification of asymptomatically infected persons and of symptomatic persons unlikely to seek diagnostic and treatment services; c) effective diagnosis and treatment of infected persons; d) evaluation treatment and counseling of sex partners of persons who are infected with an STD; and e) pre-exposure vaccination of persons at risk for vaccine-preventable STDs” [7]. With the exception of diagnosis and treatment this article reviews each of these and their underlying evidence of effectiveness. (authors)