Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) are a major public health problem with multiple significant impacts on the world population, particularly among young people. STDs are among the first 10 causes of unpleasant diseases in young adult males in developing countries and the second major cause of unpleasant diseases in young adult women.

Adolescents and young adults (15–24 years old) make up only 25 percent of the sexually active population but represent almost 50 percent of all newly acquired STDs. In general, sexually transmitted diseases can be considered today as epidemics and present enormous health and economic consequences. In this setting, is important to consider that many times STDs can occur simultaneously in one individual or in one couple (e.g., infection due to Chlamydia and Neisseria gonorrhoeae).

From an epidemiological and public health perspective, an adequate screening for STDs should be done on a routine basis in every part of the world, particularly in those countries with high incidence of such conditions and known significant prevalence of risk factors [Page 432]among the population (e.g., high rates of prostitution). Specifically, screening should be directed at the most vulnerable groups, such as pregnant women in the antenatal programs (including at least a test for human immunodeficiency virus [HIV], hepatitis B virus, and syphilis). The burden of STDs at this level is also important given the potential impact on mothers and their newborns. Congenital STDs are also a public health problem of relevant significance. They carry significant medical, economic, societal, and emotional burden, although this has been poorly characterized. Inexplicably, the fight to eradicate many of the congenital STDs has failed to attract international attention compared to HIV. The magnitude of this disease burden globally rivals that of HIV infection in neonates but receives little attention in some countries where the seroprevalence is even higher. Despite national policies on antenatal testing and the widespread use of antenatal services, sexually transmitted disease screening is still implemented only sporadically in many countries, leaving these diseases undetected and untreated among many pregnant women. Even with high antenatal care coverage, the quality of the screening should be regularly monitored. Weak organization of services and the costs of screening are the principal obstacles facing programs. Antenatal screening and treatment programs are as cost effective as many existing public health programs, such as measles immunization. This needs to be reinforced even in areas of low prevalence to avoid the unnecessary burden of STDs in pregnant women and children.

Clinically, many sexually transmitted diseases are asymptomatic and therefore can be difficult to control. For this reason, it is important not just to make passive diagnosis at any healthcare center but also to actively search for such diseases at the community level, particularly in highly risky places (e.g., prisons and incarcerated people), in highly risky populations, and in highly vulnerable groups.

Beyond the importance of individual diagnosis of any sexually transmitted diseases, of utmost importance is the reporting of these conditions, passive and active, for epidemiological surveillance purposes. This is done to ensure that persons who are infected will be quickly diagnosed and appropriately treated in order to control the spread of infection, and also so that partners are notified, tested, and appropriately treated. Today, most STDs are not just preventable but also very easily treated with antibiotics (e.g., penicillin, azythromycin).

...