Control of sexually transmitted infections and global elimination targets,South-East Asia Region

The World Health Organization (WHO) set targets for a 90% reduction in the incidence of syphilis and gonorrhoea between 2018 and 2030. We review trends in sexually transmitted infections in the WHO South-East Asia Region to assess the feasibility of reaching these targets. Myanmar, Sri Lanka and Thailand reported 90% or greater reductions in the incidence or prevalence of syphilis and/or gonorrhoea between 1975 and 2005. Evidence suggests that smaller, more recent reductions in trends in sexually transmitted infections in India have driven regional declines. In other countries, sexually transmitted infections remain high or are increasing or data are not reliable enough to measure change. Sri Lanka and Thailand have strong control programmes for sexually transmitted infections that ensure universal access to services for these infections and targeted interventions in key populations. India and Myanmar have implemented targeted control efforts on a large scale. Other countries of the region have prioritized control of human immunodeficiency virus, and limited resources are available for other sexually transmitted infections. At national and subnational levels, data show rapid declines in sexually transmitted infections when targeted promotion of condom use and sexually transmitted infection services are scaled up to reach large numbers of sex workers. In contrast, recent outbreaks of sexually transmitted infections in underserved populations of men who have sex with men have been linked to rising trends in sexually transmitted infections in the region. A renewed and focused response to sexually transmitted infections in the region is needed to meet global elimination targets.     

Sexually transmitted diseases

The "traditional" venereal diseases account for a small fraction of the sexually transmitted diseases prevalent in industrialized societies. The clinical as well as the public health impact of the widening range of STDs is discussed.     

Sexually transmitted infections in the XXI century

Sexually transmitted infections in the XXI century. The most important measurements in the management of sexually transmitted diseases are discussed. Course and incidence of classical venereal diseases, especially that of syphilis are detailed. In 2004 the incidence of early infectious syphilis significantly increased and it is emphasized that this tendency can be observed also in 2005. Differential diagnostic issues of male and female urogenital diseases with discharge are reviewed, and problems of STDs of viral origin (genital herpes, genital warts, HIV infection) are briefly discussed. The importance of careful and specific microbiological diagnostics in the management of patients with venereal diseases and other sexually transmitted infections is emphasized.     

Knowledge of sexually transmitted diseases and attitudes towards them in populations at risk in Djibouti

Sexually transmitted diseases (STDs) are an increasing public health problem in Djibouti. The authors have attempted to obtain basic information on the level of knowledge concerning STDs and on the sexual behaviour of highly sexually promiscuous individuals for use in the organization of future STD control programmes; the information was obtained from a population of 213 bar hostesses, 66 unlicensed prostitutes, and 115 male sufferers from STDs. The level of knowledge of these diseases was very high among the prostitutes and the bar hostesses, except that little was known about syphilis by the bar hostesses; the male sufferers were relatively ignorant concerning both syphilis and AIDS. Medical and paramedical personnel do not figure among the sources given for knowledge of STDs. On the other hand, friends play an important role in this knowledge, especially among unlicensed prostitutes. The second most frequently instanced source was radio and TV. The bar hostesses and the unlicensed prostitutes often exhibited distinct social characteristics. Neither education nor marriage appeared to prevent men from contracting STDs. The use of condoms is extremely rare among STD patients and not very common among unlicensed prostitutes. Half the bar hostesses report their frequent use.     

Condylomata acuminata: a rare symptom of ubiquitous human papilloma virus and not a sign of risky sex behavior]

In general, condylomata acuminata can be diagnosed and treated by the general practitioner. Condylomata are caused by certain types of human papillomavirus (HPV). According to their carcinogenicity HPVs are classified as high risk and low risk HPV. The benign condylomata are an infrequent sign of an infection with low risk HPV, while cervical cancer is a rare and late complication of an infection with high risk HPV. Because high and low risk HPV are different viruses, the risk of cervical cancer is not increased by condylomata. Anogenital HPVs are predominantly transmitted sexually. It is useful to discriminate between sexually transmitted diseases (STDs) that are ubiquitous, like infections with HPV or herpes simplex virus (HSV), and rare STDs like syphilis, gonorrhoea and HIV infection: infections with HPV and HSV are also common with unriskful sexual behaviour, while syphilis, gonorrhoea and HIV infection are almost exclusively associated with riskful sexual behaviour. It has been shown that double infections with HPV and Chlamydia trachomatis are not more frequent than may be expected by chance. The literature indicates that the presence of condylomata acuminata by itself is no reason to screen patients for other STDs.     

A community–based approach to the control of sexually transmitted diseases in the Northern Territory

Abstract: A program to control sexually transmitted diseases (STDs) was undertaken during a Men's Health Week in a remote Aboriginal community in Western Arnhem Land, Northern Territory. A total of 151 men aged 13 years and over who attended over a five–day period underwent a full physical examination, and first–void urine specimens were tested for the presence of leukocytes, chlamydia (by enzyme immunoassay antigen detection) and gonorrhoea (by culture and antigen detection). Blood was taken for syphilis serology from all patients and for human immunodeficiency virus (HIV) from patients with a proven STD or at the patient's request. Consent for testing was obtained from all participants. Patients with a positive urinary leukocyte test or symptoms were offered urethral swab investigations and treated empirically according to a set protocol. Patients with STDs detected by subsequent laboratory investigations were followed up and treated. The overall prevalence of one or more of syphilis, gonorrhoea or chlamydia was 17.4 per cent. No men presented with genitourinary symptoms and none was HIV–infected. In this population, STDs were an important cause of morbidity, and a community–based approach was adopted to identify infected persons. The use of urine for the detection of gonorrhoea and chlamydia was highly acceptable. Although not used in this study, polymerase chain reaction and ligase chain reaction technology will facilitate similar activities in the future. ( Aust N Z J Public Health 1997; 21: 519–23)     

某市性病流行特征及数学模型在发病趋势中的应用

目的：探讨广州市近5年性病疫情流行特征，为政府部门制订预防控制措施提供科学依据。方法：对近5年性病疫情报告资料进行流行病学分析，并对近5年性病报告发病率进行曲线拟合，运用线性模型预测未来3年广州市性病发病率。结果：广州市近五年性病报告发病率逐年下降，但AIDS／HIV、胎传梅毒及三期梅毒发病数及发病率呈上升趋势；性病人群中老年患者人数增加。拟合的4种数学模型均有统计学意义，其中以直线模型为佳。经预测，未来3年性病发病率仍保持下降势态。结论：根据近几年性病流行特征及未来几年发病趋势，该市应及时调整性病工作防治策略及控制工作重点。     

The role of training in STD prevention and control

The World Health Organization (WHO) estimates that 340 million new cases of curable sexually transmitted diseases (STDs) (excluding HIV and herpes simplex virus) occurred in 1995. The level of infection with STDs is especially troubling in developing countries, where they cause considerable morbidity. The consequences of infection with STDs can be personal, social, and economic. STD control programs are based upon the principles of primary and secondary prevention. Primary prevention strategies involve preventing the occurrence of new infections, while secondary prevention strategies aim to improve the management of STDs, and thereby to reduce their transmission and subsequent associated morbidity and mortality. Both primary and secondary prevention strategies require the dissemination of information from health workers to the at-risk population at a grassroots level, usually in primary health care centers. Health workers must therefore have a comprehensive and up-to-date knowledge of the many aspects of STDs, and be confident in their ability to communicate that information to others. A study in Tanzania determined that improvement in primary health care, including the provision of worker training, resulted in a 40% reduction in the incidence of HIV. The Wellcome Trust's new Topics in International Health series provides information on STDs on an interactive CD-ROM covering the epidemiology, diagnosis, clinical features, and treatment of the major STDs, except HIV, which is the subject of a separate CD-ROM. The CD-ROM was designed to be used in training programs for medical students and health care workers.     

International travel and sexually transmitted diseases

Sexually transmitted diseases (STDs) are a group of communicable diseases transferred mainly by sexual contact. Population movements are undoubtedly a major contributing factor in the spread of STDs. Owing to the ease of modern travel, larger numbers of people are moving around than ever before in peacetime. Travellers may both import and export infection, and the importance of their role in the transmission of STDs is demonstrated by the rapid worldwide spread of penicillinase-producing strains of N. gonorrhoeae (PPNG) and AIDS. While in most industrialized countries the incidence of the classic STDs (syphilis, gonorrhoea, chancroid) has decreased during the last decade, they remain hyperendemic in many developing countries due to poorly developed STD services. In many industrialized countries, the incidence of genital C. trachomatis infection now exceeds that of gonococcal infection. Chlamydial infections were previously thought to be infrequent in developing countries, but recent research has made it clear that this infection is at least as frequent as gonorrhoea. Incidence of genital herpes and genital human papilloma-virus infections (HPV) has increased dramatically during the last 20 years. Now that international travel takes place increasingly by air, it is more likely than previously for a traveller to return home within the incubation period of many STDs. Moreover, people behave differently when they travel. Tourists travel to seek adventure and new experiences, including sex. In countries where a good notification system exists, up to 30% of new cases of syphilis were found to be acquired abroad. Since PPNG appeared in 1976, these strains have spread to almost all areas of the world. During the first five years of the epidemic, most cases in Europe and the United States of America were imported. Measures for preventing STDs are the same whether the individual is travelling or not. Abstinence or sexual intercourse between two mutually-faithful uninfected partners exclusively are the only totally effective prevention strategies. The risk of infection can also be significantly reduced by adopting safe sexual practices such as the use of condoms. Prophylactic use of an antibiotic is not recommended, however.     

World Health Organization global oral health strategies for oral health promotion and disease prevention in the twenty-first century

Despite great improvements in oral health in the past decades, oral disease remains a major public health problem worldwide. The burden of oral disease is particularly high among the disadvantaged population groups in both developing and developed countries. The pattern of oral disease reflects distinct risk profiles across countries that are related to living conditions, lifestyles, environmental factors, and the availability and accessibility of oral health services. In several developing countries, people at large do not benefit from preventive oral health programmes. It is expected that the incidence of dental caries will increase in the near future in many of these countries as a result of growing consumption of sugars and inadequate exposure to fluorides. With the rising use of tobacco in developing countries, the risk of periodontal disease, tooth loss and oral cancer may therefore increase. Several oral diseases are linked to non-communicable chronic diseases or conditions that share common risk factors, such as diabetes, obesity and cancer. Similarly, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public health programmes through implementation of effective oral disease prevention measures and health promotion is urgently needed, and use of common risk factors approaches should integrate oral health within national health programmes. The challenges to oral health improvement are particularly high in developing countries. The World Health Organization Global Oral Health Programme formulates policies and actions for the improvement of oral health, strategies that are fully integrated with chronic disease prevention and general health promotion. At the 60th World Health Assembly in 2007, the WHO Member States agreed on an action plan for oral health and integrated disease prevention, thereby confirming the approach of the Oral Health Programme. The policy forms the basis for future development of oral health programmes.     

Progress toward the 1990 objectives for sexually transmitted diseases: good news and bad

The problem of sexually transmitted diseases (STDs) in the United States has been growing, in both scope and complexity, at an alarming rate. As evidence of the emergence of these diseases as a primary national concern, the Surgeon General has designated them as 1 of 15 priority areas in which further actions are required to improve the health of the American people. The key targets for the 1990 objectives for the nation in the STD area include reducing the incidence of gonorrhea; gonococcal pelvic inflammatory disease; and primary, secondary, and congenital syphilis. This report updates progress toward these objectives. There is good news with respect to the continuing success of proven methods in preventing and controlling both gonorrhea and syphilis. However, the picture is less bright with respect to control of other STDs that have gained new prominence--Chlamydia, herpesvirus, human papillomavirus, and human T-cell lymphotropic virus type III infections. Escalating interest in STDs reflects more recent appreciation of their relation to reproductive outcomes. STD organisms clearly have a far-reaching effect on the nation's population, including the capacity to reproduce, the rate of perinatal infection, the incidence of genital cancers, and the occurrence of acquired immune deficiency syndrome (AIDS).(ABSTRACT TRUNCATED AT 250 WORDS)     

Folk Constructions of Syphilis in an African-American Community in Houston,Texas

This paper analyses folk constructions of syphilis in a predominately African-American community in Houston, Texas. In-depth interviews with 17 African-Americans were conducted to describe the folk models of syphilis present. Interviews centred on prevalence transmission, risk, personal protection and detection, relationships and expectations for the future. Physical appearance, the earwax test, the match test and the smell test were used to 'detect' syphilis infection. Respondents conflated the symptoms of several STDs including syphilis, gonorrhoea, herpes and chlamydia into a single class. The study findings indicate miscommunication regarding STD information and use of different models (folk vs. medical) to explain risk of infection and prevention. The use of folk constructions in syphilis interventions would provide a better understanding of the community's knowledge and perceptions of STDs and a better focus for future education and prevention programmes.     

Sexually transmitted diseases in Poland in 2003

In 2003 year 982 cases of all forms of syphilis were notified in Poland; incidence 2.57 per 100 000 population. The largest number of cases was in mazowieckie (257), dolno?laskie (124) and slaskie (131) voivodeships. The lowest was registered in kujawsko-pomorskie (13), opolskie (14) and swietokrzyskie (15) voivodeships. There were 446 recognized cases of early symptomatic syphilis and 13 cases of congenital syphilis. Latent syphilis (early and tarda) was diagnosed insufficiently due to decreased number of screening studies. In 2003 year there were 941 932 serum samples tested toward sexually transmitted diseases--it is 35% of the number of 1999 year. In 2003 year there were 670 cases of gonorrhoea notified; incidence 1.75 per 100 000 population. The lower number of venereal diseases notified in 2003 does not imply the actual smaller number of illness (cases). It suggests the less number of case reports. It is necessary to increase the budget assigned to diagnose and cost-free treatment of all venereal patients.     

The frequency of venereal disease among seafarers

Venereal diseases are known to occur most frequently in the age-groups of greatest sexual activity and more frequently among people in certain occupations (e.g., migrant labourers, military personnel and seafarers) than among the general population. The Brussels Agreement of 1924 and the great improvements in conditions of life at sea and facilities in ports for seafarers since the First World War raised hopes that venereal diseases would be brought under control. The discovery of penicillin and the simplification of the treatment of gonorrhoea and syphilis by its use increased this optimism. Studies undertaken between the two world wars and more recently indicate, however, that the rates of venereal diseases among seafarers continue to be considerably higher than those among the general population in the countries studied. Of particular interest are several studies concerning the treatment of suspected venereal disease on board ships not carrying a doctor. Stricter observance of the revised International Agreement of Brussels and of the minimum requirements for the training of personnel and the equipment in ports and on board ships is considered necessary.     

Using the Internet for partner notification of sexually transmitted diseases--Los Angeles County, California, 2003

An estimated one third of Internet visits by persons aged > or =18 years are to sexually oriented websites, chat rooms, and news groups that enable users to view sexual images or participate in online discussions of a sexual nature. Although so-called "virtual sex" carries no risk for transmission of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), use of the Internet to find partners for actual sexual activity does carry such risk. During 2001-2003, of 759 men who have sex with men (MSM) and who had early syphilis, 172 (23%) reported using the Internet to meet sex partners (Los Angeles County Department of Health Services [LACDHS], unpublished data, 2003). Because the Internet enables sex partners to maintain anonymity by withholding identifying information (e.g., full name, address, and place of employment), it poses challenges for public health authorities. Use of the Internet by public health authorities to notify sex partners of persons with STDs has been reported previously. This report describes two cases in Los Angeles County (LAC), California, in which public health officials used the Internet to notify partners who were otherwise anonymous. Local public health authorities might develop similar strategies to use the Internet to reduce transmission of STDs.     

Incidence of sexually transmissible disorders in clients of 2 ambulatory venereal disease clinics in Amsterdam, 1981-1987

Since 1981 sexually transmitted diseases (STD) diagnosed at the STD clinics of the Municipal Health Service of Amsterdam, are registered by sex, sexual orientation and prostitution. Numbers of diagnoses per 1,000 new consultations are compared for each group of visitors over the period 1981-1987. Among heterosexual visitors there has been a steady decline of gonorrhoea and trichomoniasis since 1981. Genital herpes and venereal warts after increasing until 1985 have reached a plateau. Because of the early appearance of these trends they cannot be attributed to changes in heterosexual behaviour brought about by the AIDS epidemic. Nongonococcal urethritis has been increasing since 1981, possibly due to insufficient Chlamydia trachomatis detection in the country. After several years of decline, early syphilis has been increasing since 1987 among heterosexual men and women. Among homo/bisexual men the numbers of cases of gonorrhoea and early syphilis as well as the number of consultations for STD have decreased strongly since 1984, which may well be the result of changes in homosexual behaviour because of AIDS.     

枞阳县重点人群性行为学特征和梅毒感染状况调查分析

目的了解枞阳县重点人群性行为学特征及梅毒感染状况,为制定性病艾滋病防控措施提供科学依据。方法对性病门诊就诊者、孕产妇及娱乐场所暗娼人群进行面对面问卷调查,并抽取5ml静脉血进行梅毒血清学检测。结果调查暗娼40名,280名性病门诊就诊者和402例孕产妇,暗娼及性病门诊就诊者的艾滋病知识知晓率分别为47.5%和43.2%,他们在最近一次性行为中安全套的使用率分别为37.5%和28.9%。孕产妇有1.7%的人曾经患过性病,有11.7%的人有过非婚性性行为。暗娼的梅毒感染率为12.5%,性病门诊就诊者的梅毒感染率为6.4%,0.5%的孕产妇梅毒血清学实验阳性。结论梅毒已经在高危人群中流行与扩散,加强性病艾滋病宣传和干预力度,规范性病门诊及强化孕产妇保健工作是控制梅毒流行与传播的关键措施。     

台州地区2008—2009年性传播疾病流行病学分析

[目的] 掌握台州地区性传播疾病的流行现状及规律,为预防控制性传播疾病流行提供依据。[方法] 对台州市2008—2009年性病监测资料进行分析。[结果] 性病主要病种为梅毒、淋病和尖锐湿疣。性病病例中本地居民占97.1%,男女性别比为0.83∶1,20~39岁青壮年占54.9%,农民、家务待业和工人占63.8%。[结论] 台州市性传播疾病防治形势较为严峻,应加强性传播疾病的防治力度,尤其对20~40岁年龄段的年青人加强行为干预。     

Organisation of veterinary public health in the south Asia region.

In the South Asia region vast human populations are exposed daily and with considerable intensity to close contact with vast animal populations and their excreta. There is no veterinary public health unit in the World Health Organisation (WHO) South-East Asia Regional Office (SEARO) in New Delhi (India), the Western Pacific Regional Office (WPRO) in Manila (Philippines) or the Eastern Mediterranean Regional Office (EMRO) in Alexandria (Egypt). However, these offices do support a number of activities on zoonoses and food-borne diseases in WHO member countries of the region. Maintenance of the health of farmers and of their families (often termed "rural health") has assumed increasing importance in most member countries of the region. In most of the countries, there is no actual veterinary public health unit functioning as a national body common to the ministries of health and agriculture. Among the commonest zoonotic diseases prevalent in member countries are rabies, brucellosis, Japanese encephalitis, echinococcosis, tuberculosis, visceral leishmaniasis, taeniasis, salmonellosis, campylobacteriosis and leptospirosis. A national plan is necessary for each country to give priority to controlling these diseases, based on health systems research or primary health care, with intersectoral and regional cooperation through the South Asian Association for Regional Cooperation (SAARC) under Technical Cooperation among Developing Countries (TCDC). There should be a strong unit for veterinary public health in all WHO regional offices to coordinate zoonotic disease surveillance, training and control programmes in countries of the region.     

The fight against sexually transmitted diseases in Ivory Coast: what strategies can we use in the face of HIV/AIDS?

In the AIDS era, sexually transmitted diseases (STDs) have become a major health problem in developing countries, particularly in Africa. Delays in the diagnosis and treatment of such infections may result in complications, many of which primarily affect women. Epidemiological studies in Abidjan have shown that more than 10% of the pregnant women attending antenatal clinics present STDs potentially serious for their own health or that of their infants (gonorrhea, chlamydia infection, genital ulcers or active syphilis). There is evidence that STDs increase the transmission of HIV and that improving the syndromic management of STDs reduces the incidence of HIV infection. This provides a strong argument in favor of controlling STDs in areas of high HIV prevalence. In Ivory Coast, as in other African countries, a STD control program has been integrated into the AIDS control program since 1992, as recommended by the World Health Organization. During the first six years of the STD program, considerable progress was made in some areas, but not without difficulty. Simple syndrome-based decision trees have been adopted for the management of STDs in primary health care. Clinical studies have shown these therapeutic algorithms to be effective. At the same time, effective and affordable drugs for treating STDs were added to the list of essential drugs in Ivory Coast, after an international invitation to tender. The entire staff of the public health sector in Abidjan has been trained in syndromic STD management. Training is now being extended to other parts of Ivory Coast, including the private health sector and, in particular, private nurses. The surveillance of syndromic STDs, mainly genital ulcers in both sexes and urethral discharge in men, facilitates monitoring and evaluation of the STD program, following health care activities and adapting orders for drugs for treating STDs to real needs. In the near future, some parts of the STD program will be strengthened, particularly the management of sexual partners of STD patients and reduction of the cost of STD treatment for pregnant women.