Controlling Sexually Transmitted Diseases

 Sexually transmitted diseases (STDs) can cause lifelong pain, infertility, life-threatening ectopic pregnancy, blindness in newborns, and death.  In addition, HIV infections are transmitted more easily in the presence of STDs.  This report discusses the extent, diagnosis, treatment, management, and prevention of STDs.  A graph shows new cases of trichomoniasis, genital chlamydia, genital papillomavirus, gonorrhea, genital herpes, syphilis, chancroid, and HIV infections worldwide in 1990.  For each disease and pathogen, the first symptoms in women and men, the incubation period, the natural history, and transmissibility are tabulated.  The link between STDs and AIDS is highlighted, and ways to reduce the toll of STDs are presented, including making effective services accessible, getting affected people to treatment, and encouraging people to avoid STDs.  Effective management of STDs is linked to obtaining information; performing a physical examination; and diagnosing, treating, and counseling patients.  Examples of successful STD programs from 1970 to 1992 in Zambia, Sweden, the US, Kenya, the Dominican Republic, and Thailand are given.  The syndromic approach to diagnosis and treatment is presented, along with its important benefits (avoiding misdiagnosis, ease to use, provision of treatment in one patient visit) and disadvantages (failure to provide care for asymptomatic patients, especially women, and wasting drugs).  A detachable page with diagnostic and treatment tips is provided to accompany the wall chart guide to the syndromic approach to STDs published with this report.  Ways to improve care for women are centered around providing services, and enabling women to protect themselves.  A general discussion of getting services to the people focuses on the structure of STD services, the provision of appropriate treatment on the part of public and private providers, and the steady supply of the appropriate drugs purchased at low prices.  The advantages and drawbacks of combining family planning services with STDs services are presented along with a discussion on contraceptives and STDs.  The topic of getting people to services is considered with an emphasis on communication, screening, and partner notification.  A list is given of resource materials on STDs as is a description of the STD Diagnostics Initiative founded in 1990 to develop quick, inexpensive tests. Programs are described which provide outreach to high-risk populations. The report concludes with a discussion of promoting prevention through the use of condoms and the practice of monogamy.

Johns Hopkins Bloomberg School of Public Health,Center for Communication Programs,Population Information Program