CONTENTS
Chapters
- The Toll of STDs
- Reducing the Toll of STDs
- Managing STDs
- Diagnostic and Treatment Tips
- Getting Services to the People
- Getting People to Services
- Promoting Prevention—Condoms and Monogamy
HIGHLIGHTS
Population Reports is published by the Population Information Program, Center for Communication Programs, The
Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland
21202-4012, USA
Volume XXI, Number 1
June, 1993 |
Controlling Sexually
Transmitted Diseases
While AIDS seizes the headlines, other
sexually transmitted diseases (STDs) create
devastation of their own. In women STD,
can lead to pelvic inflammatory disease,
causing lifelong pain, infertility, and
ectopic pregnancy, which can kill. Children
are born with blinding eye infections. Men
are left infertile. People die of advanced
stages of syphilis. Furthermore, STDs
multiply the transmissibility of HIV, the
AIDS virus, as much as ninefold.
STDs are nearly as common as malaria—more than 250
million new cases each year, at least one million of
which will be HIV infection. Some developing-country
family planning, antenatal, and maternal and child
health clinics find that as many as 1 or 2 women in
every 10 are infected with an STD.
The Syndromic Approach
Many health care providers lack time or equipment to
diagnose STDs with laboratory tests, and many patients
may not return for test results. Therefore providers
often diagnose based on clinical judgment, and often
they are wrong.
The syndromic approach to STD patient management,
which bases diagnosis on a group of symptoms and
treats for all diseases that could cause that syndrome, could make diagnosis more accurate without
extensive lab tests and allow treatment with a single
visit. Combined with better drug supply, the approach
could make STD services more widely available through
primary care clinics. The World Health Organization,
working with STD experts, has developed step-by-step
procedures, leading from presenting symptoms through
diagnosis to treatment, to help providers use the syndromic approach. A chart published with this issue of
Population Reports offers guidelines for syndromic
case management, both with and without a microscope
or other laboratory tests.
Beyond Diagnosis and Treatment
Effective clinical services are the heart of STD
control programs. A full-fledged STD control
program also requires:
- A structure to support STD services in primary health centers.
- A reliable drug supply.
- Referral clinics.
- Epidemiologic surveillance to identify the most prevalent STDs and to track the effectiveness of
various antibiotics.
- Primary health care providers who "think STDs," watch for their signs, counsel those at risk of
STDs, and treat or refer those who are infected.
- Training suited to each practitioner's role in STD services.
- Condoms, readily and cheaply available and heavily promoted to the public. In addition,
women urgently need more effective barrier methods that they can control.
- Counseling to help
STD patients understand their illnesses, take medication correctly, and prevent
future infections. Women often need special helpto protect themselves.
- Mass-media communication to alert people to STDs, encourage them to seek treatment, promote condoms,
and support mutual monogamy.
- Methods of notifying the sexual partners of STD patients so that they, too, can be treated.
What Role for Family Planning Programs?
Family planning providers can help prevent STDs by
promoting and supplying condoms and spermicides and
by counseling clients. Also, providers need to assess
clients' risk of STDs, especially if they want intrauterine devices. Many programs want to do more. At
the least, they can ask clients about STD symptoms
and refer them elsewhere for diagnosis and treatment.
More difficult but more valuable is screening every
client, since STD infections often produce no immediate symptoms in women. A few programs diagnose and
treat STDs. STD prevalence and program resources vary,
and each family planning program must decide how it
can help.
Most STDs can be treated. All can be prevented. STD
programs have reduced spontaneous abortion due to
syphilis in Zambia, made gonorrhea a rarity in Sweden,
and avoided thousands of AIDS cases in Kenya by preventing other STDs. Similar successes around the world
require a commitment to making STD prevention and
treatment widely available. |
