STD control in less developed countries: the time is now.

Abstract

This discussion of sexually transmitted diseases (STDs) in less developed countries covers incidence/prevalence, antimicrobial resistance, sequelae, future trends, and new opportunities for STD control -- technological changes, health service changes, and social and political changes. For most countries, current, population-based information on STD is lacking, yet STDs appear to be common problems in nearly all countries. The prevalence of gonococcal infection in non-STD clinic populations has been as high as 5-20%, and incidence estimates made in a few settings have ranged from 3-10% per annum. These observations may overrepresent the STD problem, yet they have been identified in countries in Asia, Africa, and the Americas. The prevalence of reactive serological tests for syphilis among antenatal clinic attendees has been as high as 10-15% in some countries of Africa and the Western Pacific. Chancroid infection is extremely common in many of the developing countries of Asia, Africa, and the Americas. Penicillinase-producing "N. gonorrhoeae" (PPNG) infections are a dramatic example of the emergence and worldwide dissemination of resistant gonococci since 1976. At this time PPNG isolates constitute over 10% of all gonococcal infections in nearly all southeast Asian and Africa settings where this problem has been explored. PPNG cause more than 50% of gonococcal infections in some settings. As a result of increasing PPNG prevalence, penicillin, previously the standard therapy for gonorrhea, has been replaced by alternative agents in many settings. A variety of antimicrobial agents are effective for PPNG infections, but these are too expensive or unavailable in many developing countries. Sequelae of STD produce enormous direct and indirect costs. Acute pelvic inflammatory disease (PID) caused by gonorrhea, chlamydia, and other STD agents is common throughout the world. In developing countries ectopic pregnancy is a common surgical emergency. Improved diagnostic tests, new approaches to treatment of STD, and development of vaccines provide opportunities for better STD control, as have changes in health care delivery. The promotion of the primary health care concept, a shift in emphasis of the international family planning programs, as well as a focus on support systems of health programs all are crucial to STD efforts, and their improvement enhances STD control possibilities. Also, greater discussion of the STD health problems has led to more serious consideration of these diseases and their control.