To study the prevalence and clinical features of extragenital forms of sexually transmitted infections (prospective observational clinical and laboratory study)

We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of pre-exposure prophylaxis (PrEP) for the prevention of HIV acquisition. The guidelines include: (i) Guidance on risk assessment prior to PrEP; (ii) Baseline assessment; (iii) Dosing schedules; (iv) Monitoring; (v) Supporting adherence; (vi) Buying generic PrEP; and (vii) Cost-effectiveness. The guidelines are aimed at clinical professionals directly involved in, and responsible for, HIV prevention, and at community advocates and organisations responsible for supporting HIV prevention strategies in those at risk of HIV acquisition. A detailed review of the evidence base is included in Section 4. Sections 5 to 7 are intended to offer practical guidance in risk assessment, starting PrEP, ongoing management while on PrEP and stopping PrEP.

There have been very limited studies of oropharyngeal gonorrhea in heterosexuals. Routine screening of oropharyngeal gonorrhea is not recommended in heterosexual contacts of gonorrhea. This study aimed to examine oropharyngeal gonorrhea positivity among heterosexuals reporting contact with a partner with gonorrhea. At the Melbourne Sexual Health Centre (MSHC), all heterosexual individuals reporting contact with sexual partners with gonorrhea are tested for genital gonorrhea. In May 2017, MSHC also included screening for oropharyngeal gonorrhea in heterosexual contacts of gonorrhea. All contacts of gonorrhea among women and heterosexual men between May 2017 and November 2018 were reviewed. Site-specific gonorrhea positivity was also calculated. One hundred ninety-one gonorrhea contacts (102 heterosexual men and 89 women) were reviewed. The median age was 28 (interquartile range, 24-33) years. The gonorrhea positivity in males was significantly higher at the oropharynx compared with urethra (18%; 95% confidence interval [CI], 11% to 26% vs 2%; 95% CI, 0% to 7%; P < 0.001); and higher at the oropharynx compared with cervicovaginal site in women (46%; 95% CI, 35% to 57% vs 36%; 95% CI, 26% to 47%; P = 0.056). Of the 100 men who did not have genital gonorrhea, 17 (18%; 95% CI, 10% to 26%) tested positive at the oropharynx. Of the 55 women who did not have genital gonorrhea, 21 (24%; 95% CI, 15% to 34%) tested positive at the oropharynx. Infection at both the oropharynx and genital sites was not associated with sex worker status in women. Overall, 89% and 40% of gonorrhea in heterosexual men and women were only in the oropharynx, respectively. Oropharyngeal gonorrhea testing among heterosexual contacts of gonorrhea may be indicated given a substantial proportion of gonorrhea contacts are only infected at this site.

AAUS guidelines 2021 revision sexually transmitted infection (STIs) diagnostic strategy for STI

Does the prevalence and degree of body dissatisfaction differ among heterosexual and homosexual men and women? Some theorists have suggested that, compared to their heterosexual peers, gay men are at greater risk for body dissatisfaction and lesbians at lower risk. Past studies examining this issue have generally relied on small samples recruited from gay or lesbian groups. Further, these studies have sometimes produced conflicting results, particularly for comparisons of lesbian and heterosexual women. In the present research, we compared body satisfaction and comfort with one's body during sexual activity among lesbian women, gay men, heterosexual women, and heterosexual men through two large online studies (Ns = 2,512 and 54,865). Compared to all other groups, heterosexual men reported more positive evaluations of their appearance, less preoccupation with their weight, more positive effects of their body image on their quality of life and the quality of their sex life, more comfort wearing a swimsuit in public, and greater willingness to reveal aspects of their body to their partner during sexual activity. Few significant differences were found among gay men, lesbian women, and heterosexual women. Many gay men (42%) reported that their feelings about their body had negative effects on the quality of their sex life, as did some lesbian women (27%), heterosexual women (30%), and heterosexual men (22%). Overall, the findings supported the hypothesis that gay men are at greater risk than heterosexual men for experiencing body dissatisfaction. There was little evidence that lesbian women experience greater body satisfaction than heterosexual women.

The objective of this study was to test the effect of a brief educational and counseling intervention on increasing the uptake of free testing for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhea (gonorrhea) among young female emergency department (ED) patients. Women are particularly vulnerable to more serious consequences of these infections due to asymptomatic presentation. Increased testing is important to detect, treat, and halt the spread of these infections among asymptomatic women. This was a randomized controlled trial. Research assistants (RAs) approached female patients in two EDs. Eligible patients were between 18 and 35 years of age, who reported having sex with males, but were not attending the ED for either treatment of sexually transmitted infection (STI) or testing for possible STI exposure. Participants responded to survey questions about their lifetime and past 3-month substance use, number of recent sexual partners, condom use, and perception of risks for chlamydia and gonorrhea infections. Following the survey, the RAs randomized participants into study control or treatment arms. Each treatment arm participant received a brief educational/counseling intervention from the RA. The brief intervention focused on the woman's personal risks for chlamydia and gonorrhea and condoms attitudes and usage. As the primary outcome of this study, participants were offered free urine tests for chlamydia and gonorrhea infection postintervention or post-survey completion, depending on group assignment. A total of 171 women completed the baseline assessment and were offered chlamydia and gonorrhea testing. The mean (±SD) age was 26 (±4.76) years, 18% were Hispanic, and 12% were Spanish-speaking only. The brief intervention that was offered to increase these women's awareness of their STI risk did not result in increased acceptance of testing; 48% in the brief intervention group accepted testing (95% confidence interval [CI] = 32% to 64%) versus 36% in the control group (95% CI = 19% to 53%). In a multivariable logistic regression, only self-identifying as being Hispanic was associated with greater willingness to be tested. Of the asymptomatic women tested (n = 71), five tested positive for chlamydia. This represents a positivity rate of 7%. There were no positive test results for gonorrhea. Women who reported high-risk factors for STI, such as younger age (≤25 years), having sex in the past 90 days without using condoms, identified substance use, or previous STI, were not more likely to accept the offer of chlamydia and gonorrhea testing. The brief intervention used in this study did not increase the uptake of testing for chlamydia and gonorrhea infections in this sample, in comparison to receiving no intervention. Although Hispanic women were more likely to accept chlamydia and gonorrhea testing, it is concerning that those women who report STI risk factors were not more likely to accept the offer of chlamydia and gonorrhea testing. Future research should focus on the refinement of an intervention protocol to focus on prior STI and lack of condom use to increase the uptake of testing among this high-risk group.

Exclusive same-sex sexual behaviour is problematic from the viewpoint of evolutionary theory because one of evolutionary psychology’s fundamental tenets is that species need to survive and reproduce. I contend that female sexual fluidity is an evolved predisposition in heterosexual women and the behaviour evolved as a result of the need for allomothering— helping each other’s offspring survive—and also providing assistance with survival of the females themselves. The Allomothering hypothesis asserts that same-sex sexual behaviour can be adaptive in condition-dependent circumstances because it promotes pair bonds that ultimately contribute to the survival of offspring. A revised definition of sexual fluidity, one that is different from the traditional definition, was devised. In this dissertation the revised definition states “sexual fluidity occurs when self-identified heterosexual (straight) or predominantly heterosexual females experience short-term fleeting physical (sexual) attraction to and/or a deep emotional connection (like romantic love) with other females in a condition-dependent circumstance.” Four studies were conducted to find evidence in support of the allomothering hypothesis. The first study compared self-identified heterosexual (mostly straight) women and men in terms of same-sex sexual experience. Overall, women more than men have engaged in various dimensions of same-sex sexual behaviour. The second study compared pornography geared toward heterosexual women and pornography geared toward heterosexual men. Female same-sex sexual behaviour occurred in almost all the top selling movies for both heterosexual women and men. The third study tested the allomothering hypothesis by having self-identified heterosexual (mostly straight) women who have engaged in same-sex sexual behaviour rate the person they had the experience with on “good mothering traits.” The more the women enjoyed same-sex sexual behaviour, the higher they rated the person they had the sexual experience with. Various aspects of same-sex sexual behaviour among heterosexual (mostly straight) women and allomothering were explored. The final study was an assessment of captive Bonobos (Pan paniscus) at the Milwaukee Zoo. Bonobos are humans’ closest genetic relative along with Chimpanzees (Pan troglodtyes). The study examined the connection between female same-sex sexual activity among bonobos in relation to pair bonding, grooming, play, and allomothering.

Exclusive same-sex sexual behaviour is problematic from the viewpoint of evolutionary theory because one of evolutionary psychology’s fundamental tenets is that species need to survive and reproduce. I contend that female sexual fluidity is an evolved predisposition in heterosexual women and the behaviour evolved as a result of the need for allomothering— helping each other’s offspring survive—and also providing assistance with survival of the females themselves. The Allomothering hypothesis asserts that same-sex sexual behaviour can be adaptive in condition-dependent circumstances because it promotes pair bonds that ultimately contribute to the survival of offspring. A revised definition of sexual fluidity, one that is different from the traditional definition, was devised. In this dissertation the revised definition states “sexual fluidity occurs when self-identified heterosexual (straight) or predominantly heterosexual females experience short-term fleeting physical (sexual) attraction to and/or a deep emotional connection (like romantic love) with other females in a condition-dependent circumstance.” Four studies were conducted to find evidence in support of the allomothering hypothesis. The first study compared self-identified heterosexual (mostly straight) women and men in terms of same-sex sexual experience. Overall, women more than men have engaged in various dimensions of same-sex sexual behaviour. The second study compared pornography geared toward heterosexual women and pornography geared toward heterosexual men. Female same-sex sexual behaviour occurred in almost all the top selling movies for both heterosexual women and men. The third study tested the allomothering hypothesis by having self-identified heterosexual (mostly straight) women who have engaged in same-sex sexual behaviour rate the person they had the experience with on “good mothering traits.” The more the women enjoyed same-sex sexual behaviour, the higher they rated the person they had the sexual experience with. Various aspects of same-sex sexual behaviour among heterosexual (mostly straight) women and allomothering were explored. The final study was an assessment of captive Bonobos (Pan paniscus) at the Milwaukee Zoo. Bonobos are humans’ closest genetic relative along with Chimpanzees (Pan troglodtyes). The study examined the connection between female same-sex sexual activity among bonobos in relation to pair bonding, grooming, play, and allomothering.

In Mozambique, sexually transmitted infections (STIs) are estimated to be prevalent, but diagnosis and treatment of curable STIs rely only on syndromic management. We examined the prevalence of four non-viral STIs and HIV-1/2, based on etiological diagnosis, associations with sociodemographic and behavioural factors, and the STI diagnostic accuracy of the vaginal discharge syndromic management in women with urogenital complaints in Maputo, Mozambique. A cross-sectional study was performed in Maputo, Mozambique, February 2018-January 2019, enrolling 924 women of reproductive age with urogenital complaints. Endocervical/vaginal swabs were sampled and chlamydia, gonorrhoea, trichomoniasis and Mycoplasma genitalium infections were diagnosed using a multiplex real-time PCR (AmpliSens; InterLabServices). Serological testing was performed for HIV-1/2. A structured questionnaire collected metadata. All data were analyzed in STATA/IC 12.1 using descriptive statistics, chi-square tests and logistic regression model. About 40% of the women were less than 24 years old, 50.8% were single, 62.1% had their sexual debut between 12 and 17 years of age, and the main complaint was vaginal discharge syndrome (85%). The prevalence of chlamydia was 15.5%, trichomoniasis 12.1%, gonorrhoea 4.0%, M. genitalium 2.1%, and HIV-1/2 22.3%. The vaginal discharge syndrome flowchart had a sensitivity of 73.0%-82.5% and a specificity of 14%-15% for the detection of any individual non-viral STI in women with urogenital complaints. In total, 19.2% of the symptomatic women with chlamydia, trichomoniasis or gonorrhoea would not be detected and accordingly treated using the vaginal discharge syndromic management (missed treatment) and 70.0% of the women would be treated despite not being infected with any of these three STIs (overtreatment). In conclusion, a high prevalence of especially chlamydia, trichomoniasis, and HIV-1/2 was found in women of childbearing age with urogenital complaints in Maputo, Mozambique. Syndromic management of vaginal discharge revealed low accuracy in the detection of STIs in symptomatic women, especially low specificity, which resulted in under-treatment of STI-positive cases and incorrect or over-treatment of women with urogenital complaints, many of whom were negative for all the non-viral STIs. Etiological diagnosis is imperative for effective management of STIs in symptomatic and asymptomatic women.

In 2016, the number of people who were tested at a Dutch STI clinic for a sexually transmitted infection (STI) increased, after a decrease in 2015. The percentage of people diagnosed with an STI has also increased, to 18.4 percent in 2016. It is estimated that the number of STI consultations at the general practitioner has decreased slightly. Chlamydia remains the most common STI in heterosexuals. Gonorrhoea is more common than chlamydia in men who have sex with men (MSM). STI clinics offer high-risk groups the opportunity for free STI testing. In 2016, a total of 143,139 consultations were registered at the STI clinics, an increase of 5 percent compared to 2015. The percentage of detected STIs varied per municipal health centre (GGD), ranging from 12.8 to 20.9 percent. Most STIs were detected in people infected with HIV, followed by people who had been notified for an STI. Chlamydia In 2016, 14.5 percent of STI clinic attendees were infected with chlamydia (20,698 diagnoses; an increase of 11 percent compared to the previous year). This increase can be explained in part because, since 2015, STI clinics more strictly prioritise people with a high risk of STI. The biggest increase was seen in heterosexual men (from 16.1 in 2015 to 18.0 percent in 2016). In women, the percentage of chlamydia diagnoses increased from 14.2 to 15.4. In MSM, the percentage has been stable around 10 percent for years. Gonorrhoea The number of gonorrhoea diagnoses at the STI clinics has risen in the past year with 13 percent, to 6,092 infections. The percentage of positive tests in heterosexual men (1.7 percent) and women (1.4 percent) remained stable, compared to previous years. In MSM, the percentage has increased from 10.7 percent in 2015 to 11.3 percent in 2016. The STI clinics have not yet found cases of gonorrhoea resistant to the first option antibiotic, Ceftriaxone. The number of gonorrhoea infections diagnosed by general practitioners in 2015 saw a slight decline among women, but an increase among men of 20 percent compared to 2014. Syphilis In 2016, the number of syphilis diagnoses increased by 30 percent compared to 2015, totalling 1,223 infections. This increase is mainly caused by an increase in the number of diagnoses in MSM, both those with and without HIV. Out of all syphilis infections, 95 percent was diagnosed in MSM. The percentage of positive diagnoses in heterosexual men and women remains very low; 0.19 and 0.07 percent of all consultations that tested for syphilis, respectively. HIV In 2016, 285 new HIV diagnoses were detected at the STI clinics, approximately the same number as in 2015 (288); 93 percent was detected in MSM. The percentage of HIV diagnoses in MSM decreased, from 2.8 percent in 2007 to 0.8 percent in 2016. The number of HIV patients that had their 'first care' encounter at a Dutch HIV treatment centre decreased again, from 1,033 cases in 2015 to 976 in 2016. Out of these people, 666 received their diagnosis in 2016

Expedited Partner Therapy for Adolescents Diagnosed with Chlamydia or Gonorrhea: A Position Paper of the Society for Adolescent Medicine

INTRODUCTION : Sexually transmitted infections (STIs) are a major global cause of acute illness, infertility, long term morbidity and mortality, with severe medical and psychological consequences of millions of men, women and infants. STIs most commonly affect people aged between 15 to 44 years. In 2006, 1,030,911 Chlamydial infections and 3,58,366 Gonococcal infections were reported to CDC from 50 states and the districts of Columbia in United states. Chlamydia trachomatis and Neisseria gonorrhoeae remain the two most preventable causes of human infertility. Untreated Gonococcal and Chlamydial infections in women will result in pelvic inflammatory disease in upto 40% of cases. One in four of these will result in infertility. Demographic risk factors for the acquistion of gonorrhoeae include migration of population, unemployment, lack of education, poverty, early onset of sexual activity, unmarried marital status, past history of gonorrhoeae,illicit drug use and now commercial sex have been operative universally, but more severely in certain societies and countries. AIMS AND OBJECTIVES : 1. To study the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in patients attending the Out-Patient Department of Institute of Venereology, using AMPLICOR CT/NG Polymerase chain reaction. 2. To study the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among HIV positive patients in the study group. 3. To study about the age distribution, socioeconomic background, educational level and marital status among the patients in the study group. 4. To compare the sensitivity and specificity of AMPLICOR CT/NG Polymerase chain reaction with Culture for Gonococci and IgM ELISA test for Chlamydia trachomatis. CONCLUSION : 1. Gonococcal infections (males –14.64%, females –13.34%) was more common than Chlamydia trachomatis (males-3.57%, females –3.70%) infections. Gonococcal infection was more common in men (14.64%) compared to women (13.34%). Chlamydial infection was more common in women (3.70%) when compared to men (3.57%). 2. In HIV positive patients also, gonococcal infections (M-14%, F- 7%),were more common than chlamydial infections (M-3%, F-11%). 3. AMPLICOR CT /NG PCR for urine specimens (M-16, F-15) was highly sensitive than male urethral (13) and female endocervical swab (13) specimens in detecting gonococcal infections. In Chlamydial infections, urine PCR (7) was highly sensitive than urethral swab PCR (2) in males but in females, endocervical swab PCR(6) was more sensitive than urine PCR (3). 4. Asymptomatic gonococcal infection was common in affected males (29.26%) when compared to affected females (27.78%). Asymptomatic Chalmydial infection was common in affected females (40%) compared to affected males(20%).Asymptomatic gonococcal (M-57.14%, F- 57.14%) and chlamydial infections (M-66.67%, F-100%) were common in HIV positive patients compared to HIV negative patients. 5. AMPLICOR CT/NG PCR had 100% sensitivity in detecting gonococcal infections compared with gonococcal culture and also had 100% sensitivity in detecting chlamydial infections compared with IgM ELISA for C. trachomatis. 6. Majority of gonococoal (M-43.90%, F-47.23%) and Chlamydial (M- 50%, F-60%) infection positive patients belonged to 20-29 years age group. Majority of the affected patients belonged to lower socioeconomic status. 7. Burning micturition (NG-53.65%, CT-80%) was the main complaint in affected males and genital discharge (NG-50%,CT-50%) was the main complaint in affected females. In gonococcal infection positive males, urethral discharge (14.63%) was the common clinical finding and in chlamydial infection positive males genital ulcer (30%) was the common clinical finding .Cervical erosion (NG-58.34%, CT-70%) was the common clinical finding in affected females. 8. In Chlamydial infection positive patients, gonococcal infection was the most commonest associated STI (M-30%, F-70%). In gonococcal infection positive males, C. trachomatis (7.31%) was the commonest associated STI and in females, Bacterial vaginosis (41.67%) was the commonest associated STI. AMPLICOR CT/NG PCR had 100% sensitivity in detecting gonococcal and chlamydial infections. PCR screening will diagnose asymptomatic cases of both gonococcal and chlamydial infections. Since coinfection rate of gonococcal and chlamydial infection were high, all cases of gonorrhoeae should be treated presumptively for chlamydial infection as recommended by CDC and WHO.

Lesbian women may perceive themselves to be at lower risk for sexually transmitted infections (STIs) and use reproductive health care at lower rates compared with heterosexual women. Therefore, STIs in sexual minority women may go undetected. The prevalence and risk factors of urogenital STIs in women of different sexual orientations were investigated. This is a cross-sectional study of women attending the STI clinic of Howard Brown Health Center in Chicago, Illinois. Women were eligible for inclusion in this study if they reported a sexual identity and were screened for urogenital gonorrhea (GC)/chlamydia (CT) in the clinic between January 2008 and December 2011. Among the 669 women studied, the urogenital prevalence of GC was 1.5% and that of CT was 5.2%. Gonorrhea and CT were only diagnosed in women with recent male sex partners, but sexual identity was not necessarily consistent with sexual partner sex, and women of all sexual orientations were diagnosed as having STIs. Bisexual and heterosexual women had similar diagnosis and STI history rates, whereas lesbian women had a significantly lower history of STIs. Bisexual women had more sex partners than heterosexual or lesbian women, and their partners were less likely to be monogamous. Compared with heterosexual women, sexual minority women had twice the odds of drug use in the last year. Chlamydia and GC were diagnosed in sexual minority women, and several cases would have been missed if lesbian women were not tested for STIs. High rates of substance use among sexual minority women highlight the need for targeted interventions.

Prior research has quantitatively examined why heterosexual men and women report different numbers of lifetime different-sex sexual partners, whereas qualitative work has analyzed how men's masculinity-and to a lesser extent, women's femininity-is tied to gender norms about sexual activity. Less research, however, has quantitatively examined the associations between self-rated masculinity and femininity and reported number of lifetime sexual partners. This brief report uses a large sample of Canadians (n = 2117) to examine how self-rated masculinity and femininity relate to reported numbers of sexual partners among four groups of cisgender people: (1) heterosexual men (n = 972), (2) heterosexual women (n = 979), (3) gay and bisexual/pansexual men (n = 99), and (4) lesbian and bisexual/pansexual women (n = 67). Results demonstrate that self-rated femininity was negatively, and masculinity positively, associated with reported numbers of lifetime different-sex sexual partners among heterosexual women. No significant associations emerged for other groups. The lack of significant associations among heterosexual men may be attributable to the fact that most rated themselves as very masculine and not very feminine, whereas there was more variation among heterosexual women. In contrast, the non-significance among LGBQ women and men could reflect that subcultural norms and practices more strongly shape the number of sexual partners individuals report having in these communities. These results demonstrate that it would be beneficial for researchers to measure self-rated masculinity and femininity in future studies about sexual partnering practices, especially among heterosexual cisgender women.

AimPrevious evidence suggests that some fields of cognitive function are man dominated while others are woman dominated. Recent research has additionally associated sexual orientation with cognitive function. However, data on the effect of sexual orientation on various cognitive subdomains are limited. We aim to explore the variability in a range of cognitive subdomains (working memory, language, attention, processing speed, and executive functioning) by cis-gender hetero versus homo sexual orientation.MethodsWe combined NHANES 2011–2012 and NHANES 2013–2014 datasets to study the individuals (60-69 years old) with both sexual health and cognitive assessment data. We analyzed the data to assess the performance of heterosexual and homosexual men and women on various cognitive function assessments. We used 1) word learning and recall modules from the Consortium to Establish a Registry for Alzheimer's disease (CERAD) to examine new verbal learning, immediate and delayed memory; 2) the Animal Fluency test (AFT) to evaluate verbal sematic fluency and 3) the Digital Symbol Substitution test (DSST) to assess attention and processing speed. Mentally impaired individuals or participants who were unable to understand or read English, Spanish, Korean, Vietnamese, traditional or simplified Mandarin, or Cantonese were not asked questions regarding sexual orientation and hence, were excluded from final analysis. Simple Linear regression models were used to quantify the association of sexual orientation and cognitive function. Statistical significant was specified at P < 0.05.ResultsOur study population consists of 61 homosexual adults (39 men and 22 women) and 3087 heterosexual adults (1486 men and 1601 women). Comparison of heterosexual men and women demonstrated differences typically found between the genders, with heterosexual women performing significantly better on all cognitive function assessments. Homosexual men scored significantly higher than heterosexual men on all cognitive function assessments and performed in the direction of heterosexual women in all cognitive domains. In fact, mean scores for homosexual men were even higher than for heterosexual women in the four of the six cognitive domains tested (CERAD 2 and delayed recall, AFT and DSST). Homosexual women did not differ from heterosexual women and homosexual men on any of the measures of cognitive performance. Therefore, as expected, homosexual women scored higher points than heterosexual men on most cognitive assessments (CERAD 1,3 and delayed recall, and DSST).ConclusionHomosexual men were gender-atypical and performed in the direction of heterosexual women in cognitive domains related to working memory, language, attention, processing speed, and executive functioning. Homosexual women were sex-typical with cognitive skills similar to heterosexual women. These findings underscore the need for further studies to understand the association of sexual orientation with cognitive functioning.Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Sexually transmitted diseases (STD) are defined as a group of communicable diseases which have in common that they are transmitted predominantly by sexual contact. The number of agents now known to be sexually transmitted include some 20 pathogens. Some of these agents (such as Chlamydia trachomatis, herpes simplex virus, human papilloma virus, hepatitis B. virus, human immunodeficiency virus) tend to replace the classical "venereal diseases" both in importance and frequency as these agents are often more difficult to detect, treat, and control. Sexually transmitted diseases are a major public health problem in most African countries on account of their frequency, their associated morbidity and mortality, their impact on maternal and infant health, as well as their economic costs in terms of health expenditure and lost productivity, and, last but not least, because of their social consequences. Recent epidemiological studies using sophisticated diagnostic technologies greatly extend our knowledge on the true spectrum of complications and sequelae associated with these infections. Nongonococcal urethritis - caused to 40% by Chlamydia trachomatis - and gonococcal infections are together the most frequent sexually transmitted diseases. The increasing importance of chlamydial infections, in contrast to a gradual decrease of gonococcal infections, is related to the fact that these infections Sexually transmitted diseases (STD) are defined as a group of communica- ble diseases which have in common that they are transmitted predominantly by sexual contact. The number of agents now known to be sexually trans- mitted include some 20 pathogens. Some of these agents (such as Chlamydia trachomatis, herpes simplex virus, human papilloma virus, hepatitis Br virus, human immunodeficiency virus) tend to replace the classical "vene- real diseases" both in importance and frequency as these agents are often more difficult to detect, treat, and control. Sexually transmitted diseases are a major public health problem in most African countries on account of their frequency, their associated morbidity and mortality, their impact on maternal and infant health, as well as their economic costs in terms of health expenditure and lost productivity, and, last but not least, because of their social consequences. Recent epidemio- logical studies using sophisticated diagnostic technologies greatly extend our knowledge on the true spectrum of complications and sequelae asso- ciated with these infections. Nongonococcal urethritis - caused to 40% by Chlamydia trachomatis - and gonococcal infections are together the most frequent sexually transmitted diseases. The increasing importance of chlamydial infections, in contrast to a gradual decrease of gonococcal infections, is related to thefact that these infections frequently cause asymptomatic or mild disease and do not motivate patients to seek medical care, resulting in an extended period of infectivity and high risk of developing complications. Untreated gonorrhoea and chlamydial infections are the most common causes of epididymitis in males under the age of 35 years and may lead to decreased fertility. In some parts of sub-saharan Africa where urethritis often goes untreated, epididymitis is the leading course of male infertility. Also urethral strictures still from a large part of urogenital practice in some African countries. An estimated 8-16% of women with untreated endocervical gonococcal or chlamydial infections will develop acute salpingitis following an ascending spread of these pathogens. After one episode of acute salpingitis approximately 10% of women may become infertile due to complete tubal occlusion. Similarly, the risk for women to develop an ectopic pregnancy after salpingitis is 6-10 times greater than in controls. Ectopic pregnancies in areas with insufficient health services carry a high mortality risk. Maternal infections with STD may not only have adverse effects on pregnancy outcome but may cause serious morbidity and mortality in the newborn (e.g. congenital syphilis, ophthalmia neonatorum, herpes simplex virus infection of the neonate, chlamydial pneumonia, congenital HIV infection). AIDS is an example "par excellence" of a sexually transmitted disease of public health importance requiring extensive clinical services and posing enormous financial and social problems for the individual and the society at large. AIDS and the other viral STD have greatly increased the interest in primary prevention strategies such as health education and behavioral modification, for the control of sexually transmitted diseases.KEYWORDS: chancroid, chlamydia, gonorrhoea, HIV, infertility, sexually transmitted diseases, surveillance