Sexually Transmitted Infections Services Research Articles

Sexually transmitted infections and risk behaviours in women who have sex with women

Objectives: To assess the prevalence of sexually transmitted infections (STIs) and blood borne viruses, risk behaviours, and demographics in women who have sex with women (WSW). Methods: Retrospective cross sectional...

HIV, sexually transmitted infections, and risk behaviours in male commercial sex workers in Sydney

Objectives: To assess prevalence of HIV and sexually transmitted infections (STIs), risk behaviours, and demographics in male commercial sex workers (CSWs)/prostitutes in Sydney. Methods: Retrospective, cross sectional study with two...

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.

Outreach programmes for female commercial sex workers.

Female commercial sex workers are at higher risk of sexually transmitted infections (STI) and may be important in the transmission of infections because of their multiple sexual partners. Sexual health may not be their top priority and current STI services may not be seen as user-friendly. An outreach approach is therefore appropriate for this group. This should be in collaboration with the women and include other services that they feel are appropriate. If possible it should also incorporate the use of sex workers as peer educators.

Should management of sexually transmitted infections be integrated into family planning services: Evidence and challenges

An extensive review of what is known about efforts to integrate prevention and treatment services for sexually transmitted infections (STIs) into family planning services found that all too little empirical evidence is available. This paper summarises the key findings of the review, discusses the need for additional information on forms of integration and how they are working, and makes recommendations on gathering the type of information that will allow countries to decide whether and how to integrate these two public health services for women. One area of need is operations research, in which interventions to improve reproductive health through the provision of integrated services can be explored and evaluated. Another important focus is on modelling and costing studies that could help to clarify under what conditions integration of family planning and STI services, and what type of integration, maybe mostbeneficial in specific settings and for specific clinic populations. Further, it highlights the need for descriptive studies of examples of integration that are already in place or developing, several of which are in progress. Finally, the paper argues that even when full programmatic integration is undesirable or not planned, some specific activities that can mutually reinforce the goals of both family planning and STI/HIV programmes can be undertaken. Among these, the authors plead for urgent attention to one specific task of integration in family planning services — the promotion of dual protection among those at risk ofboth STI/HIV and unwanted pregnancy, an important task of any integrated FP/STI/HIV service provision.