Sexually transmitted diseases

Abstract

The full impact of sexually transmitted diseases (STDs) on public health in developing countries has been highlighted by the emergence of HIV infections. For 2 decades the public health implications of STDs have been recognized and research has detailed the impact of STDs on health particularly of women and children. Pelvic inflammatory disease (PID) for example causes infertility ectopic pregnancies maternal mortality and chronic pain and is the major reason women in many parts of the developing world seek gynecological help. The classic STDs (such as gonorrhea syphilis chancroid and chlamydial infection) share a primary mode of transmission with HIV infection and may interact with HIV in other ways especially because the presence of a STD seems to facilitate infection with HIV. Reduction of risky sexual behavior a primary control strategy for STDs has received a lot of attention since AIDS emerged. Now that health education campaigns are targeted to this goal it has become apparent that we have a woeful lack of understanding of human sexual behavior and its influences. Diagnosis and treatment of STDs is hampered by a lack of symptoms in the afflicted particularly in women a preference of patients to consult traditional healers and a lack of trained personnel and of drugs. This last factor is aggravated by STDs which have developed a resistance to antibiotics; to compound this problem alternate drugs are more expensive. The traditional approach to STD control should be replace by a more cost-effective and equitable integrated public health approach. STD control should be integrated in primary health care services and with AIDS control programs. Public health guidelines which prioritize STD activities should include 1) primary prevention activities 2) promotion of timely use of health services by afflicted individuals 3) the use of simple flow-charts and standardized treatment regimes for case management with minimal use of essential drugs 4) intensified interventions in high-risk groups and 5) screening for syphilis in pregnant women and prevention of optithalmia neonatorum which should be integrated in maternal and child health services. Operational research is also needed especially to develop appropriate diagnostic tools in low-resource settings. Finally women need female-controlled safe sex methods such as the female condom and viricidal agents. The low status of women prevents them from being able to negotiate for safe sex; yet the subclinical course of STDs in women can have disastrous consequences.