Family planning and sexually transmitted diseases: the need to enhance contraceptive choice

Historically, family planning services and sexually transmitted disease (STD) services have not been offered in any integrated fashion. STD control has been the almost exclusive responsibility of poorly funded vertical programs emphasizing prevention efforts in targeted high-risk groups and the treatment of individuals with disease symptoms and their sexual partners. Such interventions are the backbone of STD control and require further strengthening. Increased awareness of the expanding nature of the HIV/AIDS epidemic together with a better understanding of the epidemiology and involvement of STD, however, suggest the need for an expansion of the focus of family planning efforts beyond contraception to reflect a broader concern with reproductive health, including STDs and AIDS. All public health programs, including those which provide services to ostensibly low-risk individuals in the general population, must investigate and claim opportunities to further strengthen the prevention and treatment of STDs. The authors discuss similarities and differences in existing programs, sexual and reproductive health, the technologic dilemma, enhancing contraceptive choice, male involvement, dual method use, the special case of young people, and future prospects.     

Family planning, sexually transmitted diseases and contraceptive choice: a literature update--Part I.

Couples who use contraceptives not only protect themselves against unwanted pregnancies, but also may reduce their risk of becoming infected with a sexually transmitted disease (STD). No currently available method, however, is highly effective in protecting simultaneously against pregnancy and infection. Thus, couples who place high priority on minimizing both risks may have to use two methods. The need for contraceptive methods that provide effective protection against both pregnancy and STDs has been intensified by the HIV epidemic, but progress has been slowed by the lack of integration between the STD and family planning fields. The first part of this two-part article discusses the similarities and differences between the two fields, examines the impact of STDs on contraceptive use and services, and reviews the scientific literature dealing with the effects of condoms, spermicides and barrier-and-spermicide methods on the risk of STD transmission. Part II (which will appear in the next issue) examines what is known about the effects of oral contraceptives, the IUD, tubal sterilization and abortion on reproductive tract infections. The second part also includes a discussion of the trade-offs involved in choosing a contraceptive and presents estimates of the first-year rates of unplanned pregnancy and gonorrhea infection (given an infected partner) that would occur among women using various contraceptive methods.     

女用安全套预防性传播疾病的效果评价

目的　评价女用安全套防止非意愿性妊娠和性传播疾病的效果。方法　以 40名健康育龄妇女志愿者为研究对象 ,每人使用 5个女用安全套 ,每次使用前、后各采集阴道分泌物标本 ,记录安全套出现机械性问题的情况 ,采用化学发光免疫测定法检测标本浸泡液中前列腺特异性抗原 (PSA)浓度。结果　 186个安全套中有 18 2 7%至少出现 1次机械性问题 ;自我报告有机械性问题者的后拭子PSA平均浓度为 (3 3 3 5± 3 5 56)ng/ml,无机械性问题者的后拭子PSA平均浓度为 (14 97± 16 96)ng/ml,二者有显著性差异 (t =8 942 ,P <0 0 0 1) ;有机械性问题与PSA阳性密切相关 (r =0 77,P <0 0 0 1)。结论　尽管使用屏障性避孕工具可以有效地防止性病 /艾滋病的传播 ,但根本的预防方法还是洁身自好 ,避免婚外不洁性行为     

Trust and collaboration in the prevention of sexually transmitted diseases

High rates of sexually transmitted diseases (STDs) are sustained in communities by a relatively small group of people, referred to as the core of transmission. Definitions of the core vary but inevitably include people who are socially marginalized and who distrust people in authority, such as public health practitioners and university researchers. Having an effect on a marginalized group usually depends on effective collaboration with people they trust. Researchers from the University of North Carolina School of Public Health developed a trust-based collaboration with community members of a rural county in North Carolina to implement an STD prevention program that, in turn, relied on trust in local social networks. As part of the STD prevention demonstration project, the research team established a community resource group made up of local African Americans who helped design, implement, and evaluate the intervention. The group identified 21 women to whom others in the community turned for advice on sex and STDs. These women were trained as lay health advisors to disseminate information and skills for preventing STDs among their social networks. Through face-to-face structured interviews before and after the intervention, the authors measured improvements in STD treatment and prevention behaviors. The proportion of people practicing each of the targeted behaviors improved during the evaluation period. In addition to disseminating information through their own social networks, the lay health advisors demonstrated new skills and a desire to interact with local care providers to influence the provision of care for STDs for low-income African Americans in this county. Each participant in the collaboration played a role in establishing or building upon trust with others. These trusting relationships were critical for empowering a marginalized group at high risk for STDs.     

Renal manifestations of sexually transmitted diseases: sexually transmitted diseases and the kidney

The adolescent population is particularly vulnerable to STDs. Those that cause significant kidney disease are of viral origin. The primary VVD are HIV-1, HBV, and HCV. Screening of high-risk populations should include quantitation of proteinuria, including total protein and microalbumin, to assess severity of renal damage and potential for progression. Renal biopsy is indicated for diagnosis and for planning important treatment interventions if there is significant proteinuria or decreased renal function. Causes of acute renal failure are frequently reversible and should be treated aggressively. These include HUS, vaso-motor or ischemic acute tubular necrosis, and drug toxicities. The spectrum of chronic kidney disease associated with VVD is broad and may include systemic manifestations of vasculitis. HIV-associated nephropathy is the prototype, with the most prevalent lesion remaining FSGS. Progression occurs in up to 15% of the patients, who are overwhelmingly of African lineage. Significant advances in management include ongoing development of HAART, angiotensin antagonists to control proteinuria, and novel immune-modulating drugs such as MMF, CsA, and rituximab. Dialysis therapies have offered improved survival, especially in pediatric patients. Moreover, transplantation is no longer considered experimental and should be offered to select patients.     

Techniques of testing for sexually transmitted diseases

Adolescent and young adult women are the highest-risk group for nearly all sexually transmitted infections. This article reviews diagnostic methods for the most common bacterial and viral sexually transmitted infections, with special attention to the use of nucleic acid amplification methods, as well as the utilization of nontraditional clinical specimens. These new modalities should help the care provider identify and manage the large asymptomatic pool of infected patients, and further lower the prevalence and burden of infection.     

近些年性传播疾病的概况及其防治措施

自从20世纪80年代以来,性病(sexually transmitted disease,STD)迅速蔓延流行,严重威胁人们的生命与健康,也给社会和经济发展带来了严重影响.获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)即艾滋病,是性病的一种,与其他性病关系十分密切,其联系可以从两方面来看:一是行为因素,二是生物因素.     

Knowledge and practice of adolescents in the prevention of sexually transmitted diseases

This study aims at evaluating the knowledge of adolescents regarding the prevention and transmission of DST's, HIV/AIDS. It was carried out in a school in the city of Canoas/RS. 121 students, with age between 12-19 participated in the study. According to the interviews 22.3% said that their sexual life starts at the age between 12 and 16. Student's knowledge regarding the transmission of DST's is evident, since 79% of the students pointed out that those diseases are transmitted through sexual contact if there is no use of condoms. However some myths and stereotypes related to these disease were also identified. 16.3% of the adolescents believe that contamination can occur in bathrooms, swimming pools and saunas.     

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.     

Spread of sexually transmitted diseases

The World Health Organization has stressed the importance of preventing and controlling sexually transmitted diseases (STD) at the global level, also in light of the high costs represented by sequaele and complications for both children and adults. In industrialised countries, STD represent the most commonly notified infectious disease. Moreover, in non-industrialised, especially in Africa, STD represent the major reason for which adults seek health care. In Italy, data based on statutory notifications suggest that the incidence of gonorrhoea and syphilis has decreased in the past 20 years, though annual rates are underestimated. This report presents the data collected by the Italian System for the Surveillance of STD.     

Women and sexually transmitted diseases.

This paper presents a brief review of historical developments in women's health care. It describes the current campaign against sexually transmitted diseases (STDs) and assesses the campaign's success in light of its history and the reality of women's lives. The authors suggest that women are forced into a double-bind in which they are expected to take responsibility for the prevention of STDs although they may not have the ability to do so. Modifications are suggested which take into account gender-role socialization and social group norms.     

Circumcision and sexually transmitted diseases.

OBJECTIVES. New evidence linking lack of circumcision with sexually transmitted human immunodeficiency virus revives concerns about circumcision and other sexually transmitted diseases. This study was undertaken to assess the relationship between circumcision and syphilis, gonorrhea, chlamydial infection, genital herpes, nongonococcal urethritis, and exophytic genital warts. METHODS. A cross-sectional study of 2776 heterosexual men attending a sexually transmitted disease clinic in 1988 was used to investigate the relationship between circumcision and sexually transmitted diseases. Subjects with specific sexually transmitted diseases and those without such diseases were compared after adjustment for age, race, zip code of residence, other sexually transmitted diseases, and number of sexual partners. RESULTS. A positive relationship was observed between uncircumcised status and both syphilis and gonorrhea. A negative relationship was found between warts and lack of circumcision. No apparent relationship was noted between uncircumcised status and genital herpes, chlamydial infection, or nongonococcal urethritis. CONCLUSIONS. Uncircumcised men were more likely than circumcised men to have syphilis and gonorrhea and were less likely to have visible warts.     

Screening for sexually transmitted diseases by family planning providers: is it adequate and appropriate?

Of more than 3,000 women interviewed in the 1982 National Survey of Family Growth (NSFG) who had made at least one family planning visit in the 12 months preceding the interview, 50 percent report that they were tested for a sexually transmitted infection. Black women are far more likely to have been screened than are white women (67 percent compared with 47 percent); moreover, a racial differential is seen in every subgroup examined. There is also a large difference in the proportion screened according to the woman's source of family planning care: Those who attended a clinic are much more likely to have been screened than are women who saw a private doctor (62 percent and 43 percent, respectively). As with the race differential, this relationship persists after other variables are controlled for. In addition, women who live in the South are more likely to have been screened than are residents of other regions (58 percent compared with 46 percent). Differences by metropolitan and non-metropolitan area of residence are small and are not statistically significant. Differences by marital status and age at first intercourse appeared statistically significant in preliminary analyses, but when controls for other factors were introduced, these differences became nonsignificant. Since many characteristics that are believed to be important risk markers for sexually transmitted infections are also predictors of whether a woman will be screened for such infections, current screening practices appear, in general, to target the appropriate groups.     

2008年宁波市性传播疾病疫情分析与防制对策

目的掌握宁波市性传播疾病流行病学特征,为更好地制定有效防制措施提供科学依据。方法对宁波市各医疗和网络直报单位上报的2008年性病疫情资料汇总分析并提出防治对策。结果2008年性传播疾病年发病率为215.60/10万。男女之比为1∶0.98,患者来源绝大多数为宁波市本地户籍(90.16%),年龄主要集中在20～39岁(67.51%)。职业以工人、农民和家务及待业为主(68.26%)。5种性病中梅毒较2007年增长41.27%。结论宁波市性传播疾病年发病率平稳下降,但梅毒呈显著上升趋势,排在性病的首位。应进一步加强大众的健康教育,重点开展针对青年和目标人群的性病防制工作,大力提倡安全性行为。     

What happens behind bars: prevention strategies developed in civilian police stations against HIV/AIDS and other sexually transmitted diseases

Brazilian Preventive Healthcare Policy has implemented important strategies to combat the spread of HIV/AIDS. However, there are some individuals that are theoretically not part of society who are catching and transmitting disease, namely prisoners. This population interacts with the community by means of relatives, visitors, prison wardens and repeat incarceration. The scope of this research is to establish the strategies developed to prevent the transmission and dissemination of STD/AIDS in Civil Police stations. A qualitative study was conducted with interns of the public prisons of four cities of the region of Naviraí in Mato Grosso do Sul State, and analysis was applied using the collective subject discourse technique. Results showed that despite acknowledging the importance of prevention, the male condom is only used in the first sexual encounter, and condoms are not used when intercourse is with a steady partner. The lack of orientation in relation to prevention of STD/AIDS is well-known as is the lack of attention to the healthcare of prisoners, due mainly to prejudice and discrimination by society. It was revealed that a healthcare policy for prisoners also needs to be implemented in public prisons.     

Current protocols for diagnosis and treatment of sexually transmitted diseases

This report presents the guidelines for the treatment of individuals with sexually transmitted diseases (STD) that were developed by the STD Study Group "GIRVE" of the Società Italiana di Dermatologia e Venereologia (Italian Society of Dermatology and Venerology) in accordance with those developed by the US Centers for Disease Control and Prevention in 1998. The guidelines represent a useful tool for physicians and other health-care providers in preventing and controlling STDs. The guidelines include new recommendations for treating genital herpes and genital warts.