Sexually Transmitted Infections Control Programmes Research Articles

Sexually Transmitted Infections in Adolescents and Young Adults: A Cross Section of Public Health.

Sexually transmitted infections (STIs) can be caused by a number of microorganisms that vary greatly in size, life cycle, clinical manifestations, and sensitivity to available treatments. Transmission of STIs can occur during unprotected (or condomless) sexual contact and through the exchange of body fluids during any type of activity. The prevalence of sexually transmitted diseases remains high in the world, despite diagnostic and therapeutic improvements for these infectious diseases that rapidly eliminate the contagiousness of patients. Our study determines the prevalence of STI pathogens in adolescents and young adults in the population of the Province of Macerata (Italy). We will analyze data in correspondence to age and gender, and we will compare our results to international studies. We analyzed STI test results from the entire database of a Provincial Health Authority for the period 2021-2022. The samples came from the following age groups: 0-12, 13-18, 19-25, and 26-35 from 2021 to 2022. The results came from vaginal and cervical swabs (for females); urethral, rectal, and pharyngeal swabs (for males and females); and seminal fluid (for males) for the following infections: HPV, Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasmas, Gardnerella, Trichomonas vaginalis, Neisseria gonorrhoeae, and Treponema pallidum. The results also came from blood tests for HIV, hepatitis C, hepatitis B, and Treponema pallidum (TPHA, VDRL). In addition, we examined results from urine tests for chlamydia, Neisseria gonorrhoeae, trichomonas, and Treponema pallidum. The literature for other countries reports the need for comprehensive, culturally and developmentally sensitive care to address sexuality-related issues in adolescents and young adults, a need that also applies to Italy. These data will be of great importance in adopting evidence-based STI control programs in Marche Region. This study could, indeed, represent a landmark for public health officials and professionals, with the aim of promoting adolescents' access to sexual health services to receive useful information, strengthening preventive measures in younger age groups, and designing sexual education programs.

Knowledge, attitudes, and preventive practices towards sexually transmitted infections among youth in Tonga: local evidence to strengthen preventive actions

Background: Sexually transmitted infections (STIs) remain a public health concern due to their profound impact on sexual and reproductive health, particularly in developing countries. Many nations have investigated the root causes of STIs, however, there are limited studies published in the small island developing states in the Pacific, including Tonga. The lack of adequate information in the local context causes significant challenges to the proper planning and effective implementation of STIs prevention and control programs. Aim: This study aimed to assess the knowledge, attitudes, practices, and health seeking behaviours towards STIs among youth in Tonga, with a view to generating local evidence to strengthen preventive policies and targeted interventions. Methods: This cross-sectional study was conducted on a sample of 433 youth aged 15-24 years in Tonga. Interviews were conducted by trained interviewers using a standardised questionnaire that collected information on demographic characteristics, knowledge, attitudes, practices, health seeking behaviours towards STIs and the barriers to accessing sexual health services. The descriptive results and associations between variables were also presented. Results: Of the total youth survey, 233 (54%) were females, 277 (64%) were unemployed, and 399 (92%) were unmarried. Less than half of youth correctly identified HIV, chlamydia, and syphilis as STIs. The percentage of youth who correctly answered the routes of transmission and the symptoms of STIs were low. Infertility (51%) was the most recognised complication, and one third of youth correctly answered that cervical cancer, ectopic pregnancy, and stillbirth are some of the complications. Over 90% of youth perceived that condoms protect against the diseases; however, approximately 30% thought that the use of a condom is not required if both partners have symptoms of STIs and multiple sexual partners play no role in diseases transmission. Of the sexually active youth, only 47% used a condom the first time they had sex. The main reason was the limited availability of condoms. It was reported that 31% of females and 66% of males consumed alcohol, a contributor to risky sexual practices. Less than half of youth reported that they would access clinics if they had symptoms. The main barriers to seeking sexual health services were ‘being too embarrassed’ and issues with privacy at the clinics. Conclusion: This study highlighted the urgent need to strengthen national preventive policies and culturally acceptable targeted interventions to tackle STIs more effectively. The findings also provided a timely reminder to policymakers and health leaders to invest additional resources to effectively prevent and control; incorporate comprehensive and culturally acceptable sexual health education in schools; improve privacy, confidentiality, and accessibility of sexual health services in all relevant health care settings in Tonga.

The role of sexually transmitted infections (STI) prevention and control programs in reducing gender, sexual and STI-related stigma.

The role of sexually transmitted infections (STI) prevention and control programs in reducing gender, sexual and STI-related stigma.

Willingness to Disclose Sexually Transmitted Infection Status to Sex Partners Among College-Aged Men in the United States.

Disclosure of sexually transmitted infections (STIs) to sexual partners is critical to the prevention, treatment, and control of STIs. We examine personal intra and interpersonal influences on willingness to disclose STI status among college-aged men. Participants (n = 1064) were aged 17 to 24 years and recruited from a variety of university and community venues. Using independent-samples t test, Pearson χ test, and binary logistic regression, we examined the relationship between willingness to disclose an STI and intrapersonal and interpersonal factors, including age, masculinity values, interpersonal violence, partner cell phone monitoring, alcohol and/or drug use, condom use, number and characteristics of sex partners, and previous STI. Results reveal that among college-aged men, type of sex partner and masculinity values are significant variables in predicting whether or not an individual is willing to disclose. These data can inform STI control programs to more effectively address the complex issues associated with STI disclosure to sex partners.

Rush to judgment: the STI-treatment trials and HIV in sub-Saharan Africa.

IntroductionThe extraordinarily high incidence of HIV in sub-Saharan Africa led to the search for cofactor infections that could explain the high rates of transmission in the region. Genital inflammation and lesions caused by sexually transmitted infections (STIs) were a probable mechanism, and numerous observational studies indicated several STI cofactors. Nine out of the ten randomized controlled trials (RCTs), however, failed to demonstrate that treating STIs could lower HIV incidence. We evaluate all 10 trials to determine if their design permits the conclusion, widely believed, that STI treatment is ineffective in reducing HIV incidence.DiscussionExamination of the trials reveals critical methodological problems sufficient to account for statistically insignificant outcomes in nine of the ten trials. Shortcomings of the trials include weak exposure contrast, confounding, non-differential misclassification, contamination and effect modification, all of which consistently bias the results toward the null. In any future STI-HIV trial, ethical considerations will again require weak exposure contrast. The complexity posed by HIV transmission in the genital microbial environment means that any future STI-HIV trial will face confounding, non-differential misclassification and effect modification. As a result, it is unlikely that additional trials would be able to answer the question of whether STI control reduces HIV incidence.ConclusionsShortcomings in published RCTs render invalid the conclusion that treating STIs and other cofactor infections is ineffective in HIV prevention. Meta-analyses of observational studies conclude that STIs can raise HIV transmission efficiency two- to fourfold. Health policy is always implemented under uncertainty. Given the known benefits of STI control, the irreparable harm from not treating STIs and the likely decline in HIV incidence resulting from STI control, it is appropriate to expand STI control programmes and to use funds earmarked for HIV prevention to finance those programmes.

Sexually transmitted infections in women

Sexually transmitted infections (STIs) are highly prevalent and cause a wide spectrum of disease. However, the majority of these infections may be unrecognized due to lack of overt signs or symptoms of infection. Asymptomatic infections remain significant as a result of the potential for long-term sequelae, predominately in women, and the risks of complications during pregnancy as well as mother-to-child transmission. Laboratory diagnostics play an important role in identifying infection and in public health efforts to reduce the prevalence of these diseases. Serologic diagnosis is appropriate for syphilis and, in some settings, for herpes infections. However, the organisms that cause discharge such as Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium are best diagnosed using molecular assays. Currently available molecular assays are suitable for use with non-invasively collected sample types, most notably vaginal swabs for women thus expanding the potential reach of STI control programs to include non-clinic based screening.

Pattern of sexually transmitted infections: a profile from a sexually transmitted infections clinic of a tertiary care hospital of eastern India.

Background:Sexually transmitted infections (STIs) are public health problems, which significantly increase the risk of HIV transmission. A proper understanding of the pattern of STIs in different geographical regions is important for proper planning of STI control.Aims:To determine the pattern of sexually transmitted diseases in a tertiary care hospital in Eastern India.Subjects and Methods:This is a hospital-based, cross-sectional study done in a tertiary care hospital of Eastern India. All the consecutive patients attending the STI clinic of a tertiary care hospital from January 2011 to December 2011 were included in the study, irrespective of age and sex. Thorough history was taken; proper clinical examination and relevant laboratory investigations were done. STIs were categorized in different syndromes as depicted by National AIDS Control Organization(NACO) in the syndromic management of STIs. The STIs, which were not included in the syndromic management, were also identified by clinical features and investigations. Partner notification and condom promotion was done. The statistical analysis used was Chi-square test using MedcalcR statistical software Version 9.3 (Belgium).Results:The commonest STI was genital herpes. Viral STIs like genital herpes, condyloma acuminata, molluscum contagiosum were more prevalent than the non-viral ones like genital ulcer disease non-herpetic, syphilis. STIs which were not included in the syndromic management like molluscum contagiosum, condyloma acuminata, genital scabies were common. HIV seropositivity in the study population (4.2%) was more than the NACO estimate. Condom promotion, partner notification, and partner management was not adequate. Occurrence of venereophobia was found to be significantly higher in male than in female attendees of STI clinic.Conclusions:The trend for viral STIs is increasing while that for bacterial STIs is decreasing. Proper training of the health care providers regarding minor STIs, condom promotion, partner notification and partner management, counseling regarding venereophobia should be undertaken to make STI control programs successful.

Health-seeking behaviour of people with sexually transmitted infections in the community of Nkomazi East, Mpumalanga

The control of sexually transmitted infections (STIs) is a priority for the World Health Organization. It is estimated that there are 11 million cases of STIs per year in South Africa. Health-seeking and sexual behaviours are important in the management of STIs. The aim was to assess the health-seeking behaviour of people who had STIs in the community of Nkomazi East, Mpumalanga. The study design was a descriptive cross-sectional survey. Participants included patients who presented with confirmed signs or symptoms of an STI, were 16 years or older, voluntarily agreed to participate in the study and were residents of the community. A total of 332 questionnaires were collected. The majority of the participants were single, literate, unemployed black patients aged from 16-23 years (43.7%). Participants were very knowledgeable about STIs. Urethral discharge, painful micturition, vaginal discharge and lower abdominal pain were the most commonly recognised STI symptoms. All the participants (100%) sought help when they thought that they had an STI. Their preferred source of help was the public healthcare sector. Traditional healers were also consulted frequently. While compliance to treatment was satisfactory, ongoing unsafe sexual practices were common among participants who had active STIs. The respondents had a good knowledge of STI symptoms and signs and sought help early, usually from public healthcare facilities. STI health-seeking behaviour was influenced by multiple factors. This study suggests that STI control programmes should be designed around public healthcare facilities. However, adequate knowledge of STIs did not deter many respondents from engaging in unprotected sexual activity, sometimes with multiple partners.

Antimicrobial resistance in Neisseria gonorrhoeae and Treponema pallidum: evolution, therapeutic challenges and the need to strengthen global surveillance

The emergence of drug resistance among bacterial, viral and protozoan sexually transmitted infections (STI) in recent years threatens to undermine global STI control programmes. While this review will focus on...

Spatial distribution and cluster analysis of sexual risk behaviors reported by young men in Kisumu, Kenya.

BackgroundThe well-established connection between HIV risk behavior and place of residence points to the importance of geographic clustering in the potential transmission of HIV and other sexually transmitted infections (STI).MethodsTo investigate the geospatial distribution of prevalent sexually transmitted infections and sexual behaviors in a sample of 18-24 year-old sexually active men in urban and rural areas of Kisumu, Kenya, we mapped the residences of 649 men and conducted spatial cluster analysis. Spatial distribution of the study participants was assessed in terms of the demographic, behavioral, and sexual dysfunction variables, as well as laboratory diagnosed STIs. To test for the presence and location of clusters we used Kulldorff's spatial scan statistic as implemented in the Satscan program.ResultsThe results of this study suggest that sexual risk behaviors and STIs are evenly distributed in our sample throughout the Kisumu district. No behavioral or STI clusters were detected, except for condom use. Neither urban nor rural residence significantly impacted risk behavior or STI prevalence.ConclusionWe found no association between place of residence and sexual risk behaviors in our sample. While our results can not be generalized to other populations, the study shows that geospatial analysis can be an important tool for investigating study sample characteristics; for evaluating HIV/STI risk factors; and for development and implementation of targeted HIV and STI control programs in specifically defined populations and in areas where the underlying population dynamic is poorly understood.

Small Reservoirs: Jail Screening for Gonorrhea and Chlamydia in Low Prevalence Areas

Public health agencies can use jail as an opportunity to reach populations disproportionately affected by sexually transmitted infections (STI). The emphasis that STI control programs place on screening jail entrants varies considerably. Nine million individuals passed through U.S. jails in 2005, many in counties where STIs are rare. A pilot program of screening for Neisseria gonorrhoeae and Chlamydia trachomatis was implemented at the intake sites for the combined jail and prison system of Rhode Island, a state with a low prevalence of STIs. Prevalence of either gonorrhea or chlamydia among detainees was 4.6%, but in women aged 25 and younger, the rate was 24 times that of similar-aged women statewide. Screening led to treatment for 22 (81%) of the infected inmates and 10 of their partners. The heterogeneity of both jail demographics and STI epidemiology suggests a need to tailor the choice of screening strategy to local conditions.

Epidemiology of sexually transmitted infections on the Anangu Pitjantjatjara Yankunytjatjara Lands: results of a comprehensive control program.

To assess the impact of a long-term comprehensive control program for sexually transmitted infections (STIs) in remote Aboriginal communities in Central Australia, and to investigate a recent rise in gonorrhoea prevalence. STI prevalence was determined from annual, cross-sectional, population-wide, age-based screening, 1996-2006. During 2006, gonococcal isolates were obtained by on-site culture and tested for antimicrobial susceptibility. Six remote clinics on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, South Australia, which are served by Nganampa Health Council, an Aboriginal community-controlled health service. All resident Aboriginal people aged 14-40 years at the commencement date of each annual population-wide screen. Multivariable logistic regression models were used to compare prevalence of chlamydial infection, gonorrhoea and syphilis measured during each annual population-wide screen; antimicrobial susceptibility of gonococcal isolates obtained in 2006. Between 1996 and 2003, there was a significant reduction in prevalence of gonorrhoea and chlamydial infection, by 67% and 58%, respectively. Subsequently, chlamydia prevalence rate plateaued, but there was a rapid rise in prevalence of gonorrhoea. Syphilis prevalence decreased linearly over the study period (odds ratio, 0.81; P < 0.001). During the first 6 months of 2006, 89 gonococcal isolates were obtained, 39 through on-site culture during the 6-week screening period, and all were sensitive to penicillin (in the less-sensitive category). The decrease in STI prevalence associated with the program was maintained until 2006 for chlamydial infection and syphilis, but not for gonorrhoea, which rose in prevalence after 2003. There was no change in antimicrobial resistance to explain this rise, and gonorrhoea transmission dynamics and travel of core transmitters to regions without STI control programs might be responsible.

Investigación de infecciones de transmisión sexual en varones heterosexuales asintomáticos pareja de mujeres con neoplasia cervical intraepitelial

Introduction Human papillomaviruses (HPV) are the etiological agents of genital warts and of cervical intraepithelial neoplasia (CIN), and they are sexually transmitted. The aim of this study is to determine the prevalence of sexually transmitted infections (STI) in asymptomatic heterosexual males who consult their physicians seeking advice after their partners have been diagnosed with CIN. Methods 181 asymptomatic males whose partners were women diagnosed with CIN were studied at the STI unit in Gijón over a five-year period (1999-2003). The same diagnostic protocol was used in all cases: clinical exam, genitoscopy and the taking of samples for bacterial, fungus and Trichomonas cultures, as well as samples for the genomic detection of Chlamydia, and syphilis, HIV and viral hepatitis serology. Results 101 infections were diagnosed in 85 patients (47 %). By order of greatest prevalence, these were: urethritis from Ureaplasma urealyticum (35/181; 19.3 %), genital warts (31/181; 17.1%), Haemophilus spp. (12 de 181; 6.6%) and mycotic balanoposthitis (10/181; 5.5 %). Conclusions The prevalence of STI in the partners of women with CIN is high, and in these cases it is necessary to establish STI detection and control programs in both members of the couple.

Effect of Immune Response on Transmission Dynamics for Sexually Transmitted Infections

Transmission dynamics for sexually transmitted infections (STIs) exhibit a large degree of heterogeneity, much of which has been attributed to behavioral variability. However, because STI transmission concentrates among individuals who frequently change sex partners, immune responses also are likely to contribute to the heterogeneity in STI transmission dynamics. We review both theoretical and experimental data on the effects of immunity on STI transmission dynamics. We conclude that research should be directed more intensively toward the characterization of sexual network structures, together with qualitative and quantitative analyses of the immune responses of individuals who are identifiable within the network structure itself. Elucidation of the immunobiological and behavioral factors that shape STI transmission should inform better STI prevention and control programs.

Sexually transmitted infections in Italy: an overview.

In Italy more than 240,000 and 500,000 cases of gonorrhoea and syphilis, respectively, were reported in 1936 but the incidence progressively fell to about 200-300/year by the early 1990s; data available now are probably 100-150% underestimated. An inefficient notification system, diversion of public funding to other fields, and the progressive decline in importance of dermatovenereological centres are responsible for this decline. The advent of the HIV epidemic (with more than 47,000 AIDS reported cases) has drained most public health resources away from the very limited interventions for the control of traditional sexually transmitted infections (STIs). This has led some groups to attempt alternative approaches to the HIV/STI prevention and treatment policies; the potential of these new experiences need to be assessed. A change in culture of the medical body politic is now essential in order to support medical professionals, administrators and programme managers seeking to implement proper STI control programmes.

Increasing prevalence of genital herpes in developing countries: implications for heterosexual HIV transmission and STI control programmes.

The recognition that sexually transmitted infections (STI) facilitate HIV transmission among heterosexuals has led to a rejuvenated focus on improving STI control as a component of HIV prevention programmes in developing countries. While efforts so far have focused mainly on all STI, there is increasing evidence that genital ulcers facilitate a considerable proportion of HIV transmission among heterosexuals and that this effect has been underestimated. This paper focuses on the epidemiology of genital herpes in developing countries past and present. To review the scientific literature about the epidemiology of genital herpes in developing countries and discuss the implications of the findings for STI control and HIV prevention programmes. SEARCH METHODOLOGY: A Medline search for June 1966 to August 1999 using the keywords, genital herpes, STD and developing countries, and genital ulcers in MeSH and free text. Abstract books from recent international AIDS conferences and other international STD conferences were reviewed. The annual reports of the medical officers of heath for Harare 1982-1998 and Durban 1989-1997 were reviewed to detect trends in genital herpes diagnoses. Genital herpes, formerly regarded as a minor STI in most developing countries, has now emerged as a leading cause of genital ulceration in many countries where syphilis and chancroid were more prevalent previously. This increased recognition of genital herpes reflects both a change in the pattern of STI epidemiology through a decline in syphilis and chancroid as a response to HIV control programmes and improved techniques for diagnosing herpetic infection. Countries with significant heterosexual HIV epidemics also appear to have rapidly increasing numbers of genital herpes cases. The emergence of this herpes epidemic must be addressed through innovative strategies that will be viable, sustainable, acceptable, and effective in developing countries. In countries where genital herpes is a significant problem, local adaptation of WHO treatment algorithms should be made. STI service providers should be trained about issues around the transmission of herpes and how best to advise clients about dealing with, and recognising, recurrences. The effectiveness of antiviral treatment for genital herpes should be investigated in core groups at high risk of HIV.

Surveillance of sexually transmitted infections in England and Wales.

Surveillance of sexually transmitted infections (STIs) in England and Wales has, in the past, relied principally on aggregated statistical data submitted by all genitourinary medicine clinics to the Communicable Disease Surveillance Centre, supplemented by various laboratory reporting systems. Although these systems provide comparatively robust surveillance data, they do not provide sufficient information on risk factors to target STI control and prevention programmes appropriately. Over recent years, substantial rises in STIs, the emergence of numerous outbreaks of STIs, and changes in gonococcal resistance patterns have necessitated the introduction of more sophisticated surveillance mechanisms. This article describes current STI surveillance systems in England and Wales, including new systems that have recently been introduced or are currently being developed to meet the need for enhanced STI surveillance data.

Why include men? Establishing sexual health clinics for men in rural Bangladesh.

Subsequent to recommendations from the 1994 United Nations International Conference on Population and Development, and given recent findings outlining the links between control of sexually transmitted infections (STIs) and a reduction in HIV incidence, many countries are now seeking to establish STI control programmes. In many cases this is through a policy of providing comprehensive reproductive health care through the maternal and child health/family planning (MCH-FP) system. This involves management of all reproductive tract infections including STIs. This paper demonstrates how such an approach may miss one of the largest target groups--men. In general, men are at higher risk of initially contracting STIs, but, once infected, their clinical management is usually simpler than treating equivalent infections in women. It is argued that these two factors alone make the inclusion of men in STI control programmes critical. The paper outlines the experiences of one programme in rural Bangladesh in establishing sexual health clinics for men within the existing service structure. In response to client demand, the clinics moved beyond simple STI care towards provision of comprehensive sexual health services. Finally, the paper argues that whilst including men in sexual health programmes should never be at the expense of providing services for women, excluding them from service provision may make the objectives of STI control programmes unattainable.