Abstract

PIP: Solid evidence exists that infection with either ulcerative or non-ulcerative sexually transmitted diseases (STD) increases the risk of HIV transmission. Individuals presenting with STDs have been infected through activities which also carry the risk of HIV infection such that more than 70% of STD patients in some African cities are infected with HIV. In the interest of preventing HIV transmission, STDs also need to be prevented and controlled. Persisting high levels of STDs in many countries, however, demonstrate the need to go beyond the symptomatic treatment of patients presenting to STD clinics or other health facilities. Such an approach ignores the need to prevent people from becoming infected, misses many who need treatment, and loses many others along the way. The World Health Organization (WHO) is promoting a public health package for STDs consisting of sexual behavior change and condom promotion; improved health care-seeking behavior; the integration of STD care into primary health care services, including maternal and child care, and family planning; STD case management based upon symptoms or signs; intensified interventions for people at highest risk; the prevention and control of congenital syphilis; and ophthalmia neonatorum. Syndromic case management for STDs recommended by WHO based upon diagnosis from a consistent group of symptoms and signs, and the immediate treatment of the major infections which cause that syndrome can effectively treat more than 75% of symptomatic STDs in one patient visit. Asymptomatic people will, however, fail to be identified via this approach and no distinction will be made between specific infections within syndromes. Giving particular attention to women and children, the WHO Global Program on AIDS's Office of STD Sexually Transmitted Diseases Diagnostics Initiative is therefore working to facilitate implementation of effective control programs for STDs in all populations and to reduce the potential for HIV transmission.