Sexually transmitted infections. Initiatives for prevention

Sexually transmissible infections (STIs) are responsible for a significant burden of disease in both developed and developing countries and young people are disproportionately affected by STIs and their consequences. STI rates in young people are determined by a wide range of well documented influences. These include physiological, cognitive and behavioural factors, as well as environmental factors such as the social, and cultural context in which young people live. Despite the erecognition of these influences, their complex inter-relationships are less well documented and the evidence for interventions to reduce STIs in young people is similarly less clear. This paper explore tht most important factors that impact STI rates in young people in Australia and reviews interventions that have shown success, in Australia and elsewhere. In addition, promising strategies for the promotion of sexual health and reduction of STIs in young Australians, are discussed.     

Sexually transmitted infections in men

Under the National Sexual Health Strategy, some sexual health services are sited in primary care. Men are increasingly approaching primary care services about sexual health and professionals should be able to give accurate advice and refer them to the appropriate services. This article offers the non-specialist nurse an overview of the topic, including references to current clinical management and treatment guidelines. It discusses how and when to refer patients for a specialist opinion.     

广东省2013年性病流行状况分析

  目的  了解广东省性病门诊女性就诊者生殖道沙眼衣原体感染情况并探讨其影响因素。  方法  2016年7 —12月在东莞和中山共7家医院招募性病就诊者,收集一般人口学特征、性行为史、性病实验室检测等信息,并采用非条件logistic回归分析生殖道沙眼衣原体感染的影响因素。  结果  1 056名女性就诊者中,有生殖道沙眼衣原体感染者93人（8.8 %）。≤25岁者感染率（12.5 %）明显高于26～40岁（9.7 %）和41岁以上者（1.8 %）（P < 0.001）。多因素logistic回归显示,年龄（OR = 0.214）、月收入（OR = 0.415）、近半年安全套使用（OR = 0.292）、近一年性病症状（OR = 15.495）、本次就诊检测梅毒（OR = 0.109）可能与女性就诊者生殖道沙眼衣原体感染存在关联。  结论  广东省性病门诊女性就诊者生殖道沙眼衣原体感染率较高,应根据不同就诊者的人群特征,有针对性地进行干预。     

Sexually transmitted infections: prevention and management

In the early 21st century, STI and HIV have been linked inextricably. Although the focus of this article is STI, some discussion on the diagnosis and management of individuals with HIV infection is necessary. The history of HIV diagnosis in the workplace is checkered. The authors have seen cases of prospective workers being subjected to HIV testing without their knowledge as part of a pre-employment medical examination. If the test came back positive, the men were told that they would not be employed without explanation. This approach is a breech of the human rights of the individual being tested and cannot be condoned. Any HIV testing must be done with the full and informed consent of the individual, with counseling given before and after testing to enable individuals with HIV infection to seek care and protect their families and to give individuals without HIV infection counseling on risk reduction. Men and women who present with an STI are at risk for HIV infection. With increasing options for management and secondary prevention, it is important to recognize people who are at risk. This identification should be done through HIV VCT. The location, funding, and supervision of VCT sites related to workplace populations should be a subject for serious debate. Although fears of mass layoffs after HIV testing largely have been unfounded, it is natural for workers to be fearful, unless there is a clearly articulated policy stating that the company observes and enforces nondiscriminatory practices. The workplace examples show that syndromic STI management, allied to comprehensive prevention programs, can have a genuine and measurable impact on STI prevalence. The potential interventions and partners are listed in Table 2. A community-based, randomized study in Tanzania showed that the institution of a well-managed STI syndromic management program can reduce HIV incidence by up to 40%, in the context of a rising HIV epidemic. Presumptive STI treatment for female sex workers (see Box 1) may prove useful as a short-term measure to reduce high STI prevalence rates while more sustainable preventive and curative services are established. The laboratory diagnosis of STIs remains problematic in the face of commonly available technologies of limited sensitivity and specificity and often substandard quality-assurance practices. For these and other reasons, syndromic management became the recommended strategy for treating STIs. The availability of rapid, accurate, and inexpensive diagnostics, especially for cervical infections for women, would alter management recommendations. Work is being done by the WHO and others to develop and assess low-cost diagnostics. Managing STIs and altering the behavior that leads to STIs are essential elements of any HIV prevention and management program. The issues surrounding a practical, compassionate, and comprehensive HIV program can be difficult. Numerous publications exist to help program managers navigate these issues and appropriately tailor a program to the needs of individual organizations. Some of these publications are listed in the next section.     

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.     

Sexually transmitted infections and private physicians in Peru, 2003.

OBJECTIVES: To analyze demographic and practice characteristics of private physicians in 10 cities of Peru, and to shed light on the role of private practice in the delivery of medical care to patients with sexually transmitted infections (STIs). METHODS: As part of an interventional trial designed to improve physician management of STIs in 10 cities in Peru, detailed information was compiled regarding numbers of physicians in each city. A door-to-door survey was then conducted within each city of all private and public medical offices and institutions. Each physician encountered who had a private practice was asked to answer a questionnaire regarding demographic information, medical education, specialty, type of private and public practices currently engaged in, number of STI cases seen per month, and average earnings per consultation. RESULTS: Of 2,060 physicians working in the 10 cities, 507 reported having a private practice, either exclusively or concurrently with other clinical positions. Almost all the private physicians (97.4%) reported managing cases of STIs. Regional differences among private physicians were found in physician density, gender, and place of medical training. In addition, significant variations by gender were seen in rates of specialization, earnings per consultation, and numbers of female patients with STIs seen per month. CONCLUSIONS: Studies of the physician workforce can provide meaningful insights for potential use in addressing public health problems. This study provides valuable information that can help understand the important role of private physicians in managing STIs in Peru.     

Sexually transmitted infections: incidence and awareness among German adolescents

Despite the fact that they are largely preventable and curable, sexually transmitted infections (STIs) present a major global public health problem disproportionally affecting young persons aged 15-25 years. Several STIs can occur without, or only with mild and passing symptoms over long periods of time, leading to delayed diagnosis and treatment, and also increasing the chance of the infections being passed on during unprotected sexual intercourse. According to reports, many adolescents get information on STIs such as chlamydia and human papillomavirus only after getting infected.     

Sexually transmitted infections in the population of drug dependents

Abused drugs have several effects on sexual behaviour, which are related to the type, quantity, modality of assumption, and duration of abuse. Specifically, persons under the influence of drugs may fail to practice safe sex, increasing the risk of acquiring sexually transmitted diseases (STD) and of unplanned pregnancies. In recent years, many studies have been conducted to explore the association between drug use and the risk of STD, including HIV infection. The present paper is a review of these studies, which have been conducted in different parts of the world and among individuals with various modalities of drug assumption.     

Sexually transmitted infections. Genital chlamydia: practical management in primary care

As the number of infected people increases, more nurses outside the specialist sexual health services are being called upon to provide advice and clinical care for genital chlamydial infection. This article provides non-specialist nurses with practical information on the diagnosis, treatment, management and follow-up of clients with genital chlamydial infections.     

Sexually transmitted diseases in pregnancy.

Sexually transmitted diseases (STDs), grouped together are one of the most common medical complications of pregnancy. They can have serious adverse effects on the health of both the pregnant mother and her baby. The increasing prevalence of many STDs and the advent of human immunodeficiency virus (HIV)-related problems emphasize the need for STD awareness in the care of pregnant women.     

Sexually transmitted diseases

Sexually transmitted diseases continue to be major health problems. Syphilis and gonorrhea merit their traditional importance but other conditions (genital herpes infection, trichomoniasis, chlamydia infection, and public lice infestation) are also of a magnitude deserving attention. Current failure to control these conditions has prompted renewed interest in detection and prophylaxis, and the accelerated pace of current research promises many advances in the next few years.