Sexually Transmitted Diseases Control Programs Research Articles

The Epidemiology and Costs of Disease Intervention Specialist Retention.

The COVID-19 pandemic changed the environment in which disease intervention specialists (DIS) operate, as their skills were in demand beyond STD control programs. Workforce conditions generally have changed in the last 2 years, imposing additional challenges. Retaining STD DIS has become more difficult in the changed environment. We conducted a landscape scan and obtained data from literature and personal observations to characterize current DIS workforce issues. We used published employment data to characterize current labor market conditions and described how cost-effectiveness analysis could be used to assess potential DIS retention interventions. An example illustrating cost-effectiveness concepts was developed. Many STD control programs faced difficulties in retaining STD DIS, because competing positions often could be done without field work. Economic and crime issues posed additional challenges. General workforce turnover has increased 33% since 2016. Turnover varies by age, gender, and education. Cost-effectiveness analysis can be used to assess DIS retention interventions, but data on costs and outcomes are needed on an ongoing basis. Changes in the workforce environment could impact both retention and the effectiveness of retention interventions. Workforce changes have impacted employee retention. Increased federal funding makes expansion of the DIS workforce possible, but the labor market environment will continue to pose challenges to recruitment and retention.

Does Trichomoniasis Play Any Role in The Pathogenesis of Cervical Carcinoma?

Trichomonas vaginalis is the causative agent of trichomoniasis, a common cause of vaginitis. Despite being a readily diagnosed and treatable sexually transmitted disease (STD), trichomoniasis is not a reportable infection and its control has received relatively little emphasis from public health STD control programs. It is one of the most common non-viral sexually transmitted infections worldwide. It is associated with potentially serious complications such as preterm birth and human immunodeficiency virus acquisition and transmission. Even though several studies have demonstrated the correlation between cervical cancer and trichomonas vaginalis, the pathophysiology of this relationship is still ambiguous. This review was carried out to determine the relationship between Trichomoniasis and cervical cancer.

A Low-Cost Partner Notification Strategy for the Control of Sexually Transmitted Diseases: A Case Study From Louisiana.

We estimated the costs and effectiveness of implementing a partner notification (PN) strategy for highly prevalent sexually transmitted diseases (STDs) within the Louisiana STD/HIV Program. We carried out a telephone-based PN approach on an experimental basis in 2 public STD clinics in Louisiana from June 2010 to May 2012. We monitored data on the resources used for identifying, tracing, treating, and managing the infected cases and their partners to estimate the intervention costs. Our results indicated that implementation of telephone-based PN should not increase the STD control program's expenses by more than 4.5%. This low-cost PN approach could successfully identify and treat 1 additional infected case at a cost of only $171. We found that the cost per disability-adjusted life year averted (a health outcome measure), because of the adoption of selective screening with partner tracing, was $4499. This was significantly lower than the gross domestic product per capita of the United States, a threshold used for defining highly cost-effective health interventions. Adoption of PN for gonorrhea and chlamydia should be considered a national strategy for prevention and control of these diseases.

A study on sexually transmitted diseases in patients in a STD clinic in a district hospital in North India

Introduction: The Sexually transmitted diseases (STDs) are a global health problem of great magnitude. The pattern of STDs differs from country to country and from region to region. The increased risk of the transmission of HIV is known to be associated with the presence of sexually transmitted diseases (STDs) and despite the presence of the National STD Control Program in India the number of people with STDs remains high. Aim: The aim of our study was to study the profile of patients in a STD clinic in North India and to study various sexually transmitted infections in both male and female patients. Material and Methods: A prospective study of the patients attending STD clinic in a district hospital in North India from December 2009 to December 2012 was done. A total of 2700 patients attending the STDclinic in three years from December 2009 to December 2012 were taken up for the study. Results: The commonest sexually transmitted infection in males was herpes genitalis (30%) followed by 20% cases of genital warts. 10% patients had gonorrhoea, genital molluscum contagiosum, syphilis and genital scabies each and 5% patients had nongonococcal urethritis. Only 5% of the total patients had chancroid, donovanosis and LGV. The commonest sexually transmitted infection in females was vaginal discharge seen in 40% patients, lower abdominal pain in 20% patients, herpes genitalis in 15% patients followed by 20% cases of genital warts and syphilis each. Genital molluscum contagiosum was seen in 5% patients only. Conclusions: The treatment of STD’s is important as both non-ulcerative and ulcerative STDs increase the susceptibility to or transmissibility of HIV infection and as such, an increase in STD prevalence as revealed by clinic attendance in this study was bound to facilitate the spread of HIV/AIDS. Perhaps it is high time health planners adopted a more aggressive and result oriented HIV/AIDS/STD awareness campaign strategy.

HIV/AIDS and other sexually transmitted infections among military members of the armed forces of Serbia

Military personnel is a population group at special risk of exposure to sexually transmitted diseases (STD). In peacetime, STD infection rates among service members are generally 2 to 5 times higher than among civilian population. In time of conflict, the differences can be 50 or more times greater. This study describes sexual behavior as a risk factor for STD in the Armed Forces of Serbia. The sample of 5 617 voluntary blood donors from the Armed Forces of Serbia gave blood and filled World Health Organization Questionnaire about sexual behavior within January 2007 - December 2008 period. The mandatory testing of voluntary blood donors was performed in the Institute of Transfusiology Military Medical Academy in Belgrade, by the specific immunoenzyme tests and polymerasa chain reaction tests for HIV, hepatitis B, C and syphilis. Statistical analysis of data was done using State for Windows 93, USA, 1996. We identified 36 soldiers with some form of STDs. This study showed that 1 668 (29.7%) tested soldiers reported always using condoms, 1 725 (30.72%) almost always, 1 238 (20.04%) sometimes, 495 (8.81%) almost never and 490 (8.73%) never. Among the sample, 449 (7.99%) soldiers reported sexual contacts with partners with high risk of sexual behavior, whilst 22 (0.37%) of them reported homosexual and bisexual contacts. This study reported STDs found in voluntary blood donors among the service members of the Armed Forces of Serbia, but none of them was identified to be HIV positive. Soldiers with the most frequent risk behavior were reported to be those with inconsistent condom use. In the future, the STD Control and Prevention Program should be more intensively conducted among the members of the Armed Forces of Serbia.

Integration of Surveillance for STDs, HIV, Hepatitis, and TB: A Survey of U.S. STD Control Programs.

Integration of surveillance for sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), hepatitis, and tuberculosis (TB) may improve disease prevention and control. We determined the extent of surveillance integration in these programs, the benefits of integration, and barriers to increased integration. We e-mailed a survey to the 58 federally funded local and state STD control programs and followed up with phone interviews of nine program representatives. The response rate was 81%. Many had compared infections by population subgroup for STDs and HIV (89%), STDs and hepatitis (53%), or STDs and TB (28%). Most (74%) had examined co-infections with HIV and STDs at the individual level and entered STD and HIV surveillance data into the same database (54%). All respondents thought some integration would be useful. Many (72%) used integrated data to disseminate information or change program strategies. The most commonly reported barriers to integration were policies preventing work with HIV data (85%) and incompatible databases (59%). Most STD control programs in the United States have some experience integrating surveillance data, but the degree of integration varies widely. Specific barriers to further integration were identified. The Centers for Disease Control and Prevention can help address these barriers by facilitating access to information and sharing technical solutions. Local and state programs can continue advancing surveillance integration by improving understanding of where integrated data are needed, increasing the use of available data, and pressing for appropriate and secure data sharing.

Charting a Path to Location Intelligence for STD Control.

This article describes the New York State Department of Health's GeoDatabase project, which developed new methods and techniques for designing and building a geocoding and mapping data repository for sexually transmitted disease (STD) control. The GeoDatabase development was supported through the Centers for Disease Control and Prevention's Outcome Assessment through Systems of Integrated Surveillance workgroup. The design and operation of the GeoDatabase relied upon commercial-off-the-shelf tools that other public health programs may also use for disease-control systems. This article provides a blueprint of the structure and software used to build the GeoDatabase and integrate location data from multiple data sources into the everyday activities of STD control programs.

Trichomoniasis in Adolescents: A Marker for the Lack of a Public Health Response to the Epidemic of Sexually Transmitted Diseases in the United States

Despite being a readily diagnosed and treated sexually transmitted disease (STD) trichomoniasis is not reportable in the United States and control of trichomoniasis has received relatively little emphasis from public health STD control programs including that of the Centers for Disease Control and Prevention. More recently however appreciation of high rates of disease and of associations between trichomoniasis in women and both adverse pregnancy outcomes and an increased risk of HIV infection have suggested a need for increased control efforts. Trichomoniasis is caused by the parasite Trichomonas vaginalis. The annual incidence of T. vaginalis infection in the United States has been estimated at 7.4 million cases with 1180 million cases worldwide. The World Health Organization has estimated that this infection accounts for almost one-half of all curable STDs worldwide. The prevalence of trichomoniasis trichomoniasis in women attending inner-city STD clinics in the United States typically approaches 25% and may be higher in certain populations. In Los Angeles California for instance the prevalence in black attendees at a public clinic was found to be 38%. Rates of T. vaginalis infection in men are largely unknown because of the poor sensitivity of the currently available diagnostic techniques for men. Recent studies using more-sensitive polymerase chain reaction (PCR)-based techniques have found that in some populations rates of T. vaginalis infection in men may equal those of chlamydia infection. (excerpt)

Quality of sexually transmitted disease treatments in the formal and informal sectors of Bangui, Central African Republic.

Interventions for upgrading sexually transmitted disease (STD) management in sub-Saharan Africa have focused on the public sector, and to a much lower extent on private medical practitioners and pharmacies. However, in most African cities there is a large informal sector that provides care to many patients with STD symptoms. To compare the quality of treatments offered to patients with major STD syndromes in the public sector, pharmacies, and the informal sector of the same city. Healthcare providers in health centers, pharmacies, private laboratories, and market drug peddlers in Bangui, Central African Republic, were asked to complete a short form for every patient consulting them with genital complaints. The treatments they ordered were evaluated for their potential efficacy against the major etiologic agents of the syndrome for which the patient consulted. The majority of male patients with STDs preferred to seek care in pharmacies and in the informal sector. The STD treatments offered to patients with urethral discharge or genital ulcers in pharmacies and in the informal sector tended to focus on a single etiologic agent. The quality of STD treatments offered by drug peddlers and private laboratories was poor, apart from adequate coverage of syphilis in patients with genital ulcers and of candidiasis in women with vaginal discharge. For instance, 41% and 34% of patients with urethral discharge managed by drug peddlers and private laboratories did not receive a drug active against either Neisseria gonorrhoeae or Chlamydia trachomatis, whereas this proportion was 22% in pharmacies and 14% in health centers. For patients with genital ulcers, the proportion offered a drug active against Haemophilus ducreyi was 2% if seen by drug peddlers, 0% in laboratories, 10% in pharmacies, and 25% in health centers. For each syndrome and each category of provider, between one fourth and two thirds of patients had already received another ineffective treatment elsewhere. National STD and HIV control programs will have to improve STD management in pharmacies and in the informal sector if they are to have any impact on the dynamics of HIV infection in urban centers.

Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. American Social Health Association Panel.

Accurate, updated estimates of the incidence and prevalence of sexually transmitted infections in the United States remain elusive. The most widely quoted number of new sexually transmitted disease (STD) cases each year is 12 million. However, this figure has not changed in more than a decade, despite improvements in detection methods and the effects of STD control programs. To propose a system for weighing the strength of STD surveillance data and to estimate the incidence and prevalence of STDs in the United States for 1996, using the available published data. We estimate that more than 15 million STD infections occurred in the United States in 1996. This number exceeds the earlier estimate primarily because improved detection techniques have allowed an assessment of previously undiagnosed infections. Large numbers of new STDs continue to occur each year in the United States, with serious health and economic consequences. More than two thirds of our current estimate of 15 million STDs annually consists of two infections--trichomoniasis and human papillomavirus--for which we have only level III surveillance data. As the quality of our surveillance data improves, we can further refine the precision of our national estimates.

Community based study of treatment seeking among subjects with symptoms of sexually transmitted disease in rural Uganda

This paper presents a community based study of treatment seeking among people with symptoms of sexually transmitted diseases (STDs) in rural Uganda. The effects of asymptomatic infections and treatment seeking...

Strategies for the prevention and treatment of sexually transmitted diseases.

Sexually transmitted diseases (STDs) are among the most common causes of morbidity and mortality in the world, and have far reaching health, social, and economic consequences. Failure to diagnose and treat traditional infections such as gonorrhea, chlamydia, and syphilis can often adversely affect pregnancy and the newborn infant, in terms of miscarriage, prematurity, congenital and neonatal infections, and blindness. Other complications of infection, especially in women, are problematic. The recognition that the presence of STDs can increase the risks of both acquiring and transmitting HIV has increasingly resulted in the development of integrated control programs for HIV and STDs. The World Health Organization has estimated that 333 million new STD infections occur each year. The scope of the problem of STDs, factors associated with STD acquisition, STD control programs, primary prevention, secondary prevention, and approaches to STD diagnosis and management are discussed.

Sexually transmitted infections in female sex workers: reduced by condom use but not by a limited periodic examination program.

The sexually transmitted diseases (STD) control program for female sex workers (FSW) in Lima, Peru, provided periodic serological tests for syphilis and cervical smears for gonococci, but not medication for STD or condoms. To assess program effectiveness. We assessed prevalence of current STD and serum antibody to STD pathogens in FSW in relation to program participation and to condom use. Program participation was not associated with significantly reduced rates of current gonococcal or chlamydial infections or Venereal Disease Research Laboratory (VDRL) titers > or =4 with reactive fluorescent treponemal antibody absorption (FTA-ABS). However, regardless of control program participation, consistent condom use was associated with reduced prevalence of gonorrhea, and with significantly reduced seroreactivity for FTA-ABS, C. trachomatis, anti-hepatitis B core (HBc), and anti-human T-lymphotropic virus type I. Anti-HBc was associated with years of receiving penicillin injections for syphilis prophylaxis. The scope, quality, and efficacy of STD control programs must be technically appropriate, well managed, and adequately financed. The safety of marginal programs warrants scrutiny.

Sexually transmitted disease control in the era of managed care: "magic bullet" or "shadow on the land"?

Sexually transmitted diseases (STDs) are a major public health problem. In the United States, nearly 12 million STD infections occur annually, generating estimated direct annual health care costs exceeding $12 billion. Lifetime costs may total $88 billion. Meanwhile, inflation-adjusted public funding for STD clinical care and control decreased over the past two decades. Previous STD control officials warned that declining support for STD control programs would result in program elimination and increased rates of STDs ("Brown's Law"). Effective public health and primary prevention efforts have been difficult to implement because of societal sensitivities about sexuality, and the curative rather than preventive focus of our health care system. Proven cost-effective medical interventions, such as chlamydia screening, have not been universally implemented because of health care system inefficiencies, whereby public STD clinical services generate private sector savings not reinvested into these public prevention programs. However, the dramatic growth in managed care presents opportunities, as well as risks, for better STD management.

Sexually Transmitted Disease Control in the Armed Forces, Past and Present

Sexually transmitted diseases (STDs) present a challenge for military medical personnel in their efforts to maintain a ready and healthy force. Many tactics have been used in military STD control programs. This paper is a review of the literature outlining some past strategies used in the United States military and how they have shaped current STD policy. These efforts have included financial and administrative penalties, stigmatization and shame, screening programs, and sharing of resources with other government agencies. Punishments and stigmatization have not proven to be useful strategies and have been eliminated from current policy. Cooperation with other government agencies and screening programs are examined as tactics that have been found useful and are part of the program used by the military today to control not only the traditional STDs, but also the more recently discovered human immunodeficiency virus.

Health seeking behaviour and the control of sexually transmitted disease.

What people do when they have symptoms or suspicion of a sexually transmitted disease (STD) has major implications for transmission and, consequently, for disease control. Delays in seeking and obtaining diagnosis and treatment can allow for continued transmission and the greater probability of adverse sequelae. An understanding of health seeking behaviour is therefore important if STD control programmes are to be effective. However, taboos and stigma related to sex and STD in most cultures mean that gaining a true picture is difficult and requires considerable cultural sensitivity. At the moment relatively little is known about who people turn to for advice, or about how symptoms are perceived, recognized or related to decisions to seek help. It is argued that such knowledge would assist programme planners in the development of more accessible and effective services, that studies of health seeking behaviour need to include a combination of qualitative and quantitative methods, and that studies should include data collection about people who do not present to health care facilities as well as those who do. A pilot protocol for studying STD-related health seeking behaviour in developing countries is briefly presented.

Public Health Departments Providing Sexually Transmitted Disease Services

Results of a 1995 survey reveal that 1,437 local health departments-half of those in the country-provide sexually transmitted disease (STD) services and receive about two million client visits each year. Their clients are predominantly individuals with incomes of less than 250% of the poverty level (83%), women (60%) and non-Hispanic whites or blacks (55% and 35%, respectively); 36% of clients are younger than 20, and 30% are aged 20-24. On average, 23% of clients tested for STDs have chlamydia, 13% have gonorrhea, 3% have early-stage syphilis, 18% have some other STD and 43% have no STD. Virtually all public STD programs offer testing and treatment for gonorrhea and syphilis; only 82% test for chlamydia, but 97% provide treatment for it. Some 14% offer services only in sessions dedicated to STD care, 37% always integrate STD and other services, such as family planning, in the same clinic sessions, and 49% offer both separate and integrated sessions. STD programs that integrate services with other health care typically cover nonmetropolitan areas, have small caseloads, serve mainly women and provide a variety of contraceptives. In contrast, those that offer services only in dedicated sessions generally are in metropolitan areas and have large caseloads; most of their clients are men, and few provide contraceptive methods other than the male condom.

Successful eradication of sexually transmitted diseases in the People's Republic of China: implications for the 21st century.

The global control of sexually transmitted diseases (STDs) represents a daunting task, and there have been very few examples of success. The scope of the STD problem in China before the formation of the People's Republic and the effects of a governmental STD control program were reviewed. In major cities, 10% of the population had syphilis, reaching 50% prevalence in some rural minorities. By 1964, STDs in China were virtually eliminated through a program that destigmatized STDs, provided an infrastructure for case finding and therapy, and eliminated prostitution. The People's Republic of China demonstrated the possibility of eliminating STDs, at least for some period of time. Although the Chinese approach may not be ideal for Western democracies, understanding some features of the Chinese program may help in designing a strategy for the eradication of human immunodeficiency virus when or if treatment becomes available.

Association of sexually transmitted diseases and infection with the human immunodeficiency virus: biological cofactors and markers of behavioural interventions.

Sexually transmitted diseases (STDs) interact uniquely with HIV infection, regardless of the form of sexual transmission of HIV. Both STDs and HIV infection are behaviorally and biologically intertwined with one another. This concept is called epidemiologic synergy since they facilitate the sexual transmission of one another. Assuming that one accepts this concept, innovative and comprehensive STD control programs along with community and individual-based prevention programs should provide a more effective HIV control program by reducing the efficiency of HIV transmission in high-risk individuals. Public health workers can assess the effectiveness of these programs by monitoring incident STDs in high-risk groups. Other benefits of using incident STDs as markers for HIV prevention include: biological validation of self-reported behavioral change, possible association between self-reports of behavioral change and recall or social desirability bias, representation of a major target population for HIV programs by people at risk for STDs, and sensitive, specific, and noninvasive STD-assays. Disadvantages of using incident STDs as markers for HIV prevention are: incident STDs are unreliable for detecting deficiencies in one individual component (i.e., condom use), they can be used only in areas with a high STD prevalence and high transmission probability, STD diagnostic assays are not 100% sensitive and specific, and untreated/undetected STDs at enrollment may be mislabeled as incident STDs at follow-up. Questions remain about the validity of self-reported condom use and the use of STDs to evaluate individual intervention measures, e.g., condom use within a short period of time. Monitoring of HIV incidence would be ideal, but it may take too long. Valid measures of condom use and other risk behavior are needed to determine risk status and changes in risk status over time. Thus, further research is needed to develop more accurate measures.

Sexually transmitted diseases control in developing countries.

Sexually transmitted diseases (STDs) are a major public health problem now compounded by the advent of AIDS and HIV infection. The size of the problem represented by STDs and HIV is unknown however it is estimated that there are 333 million new cases of STD per annum and currently 15-20 million people infected worldwide with HIV. Control programmes for STDs must prevent the acquisition of STDs, their complications and sequelae and interrupt and reduce transmission. They can also reduce the incidence of HIV infection. Such programmes must place emphasis on health education, condom usage, altering health seeking behaviour and providing case management. The syndromic approach currently offers the most realistic, and cost effective, way in which to treat patients.