This 1937 analysis of the barriers to syphilis control in the USA by Thomas Parran, a former Surgeon General, helps us to understand why the control of this and other sexually transmitted infections continues to fail worldwide. Sexually transmitted infections other than HIV are significant global health problems, but are neglected by public health policy.

The University of Bern (Switzerland) and an international group of co-authors looked at studies published about sexually transmitted infections (STIs) since the 1950s. STIs, which had a high profile in the 1990s, now receive little attention and are not featured in the Millennium Development Goals. They have been overshadowed by the threat of AIDS. Controlling STIs is now usually considered as a means of helping to curb the HIV epidemic.

Women are more at risk than men of catching STIs, partly because of the way their bodies are designed. Signs of infection are often not visible until it is too late to reverse the damage. Women are often not in a position to protect themselves from catching an STI, for example, by demanding their husbands use condoms. Finally, if they are diagnosed with an STI they may be stigmatised by society and suffer violence from their partners.

For prevention of infection to be effective it must take place at three levels: by working with the individual; by considering the individual’s partner or unborn child; and by looking at the population as a whole. The study highlighted literature showing that:

• Condoms are a known way of preventing infection. Male circumcision might also protect against some STIs, as well as HIV.
• Sexual partners of people with an STI should be notified about their exposure, and treated if necessary. This should prevent reinfection of the patient and might help limit the spread of the disease. However, a female patient’s welfare must be considered if she is at risk of gender-based violence.
• Antenatal screening for syphilis protects both the mother and unborn child.
• Vaccinating teenage girls could prevent them from developing cervical cancer and passing on the carcinogenic virus to a new sexual partner.

The tests, vaccines and many of the treatments used for infected patients in developed countries are unavailable in developing countries. In these countries patients are often treated only if they show symptoms of the disease. The article recommends that:

• governments introduce laws to prevent discrimination, community education to challenge sexual inequality and policies to reduce poverty and improve education
• as well as health campaigns for the general public, there should be campaigns targeted at the groups most at risk, such as prostitutes, men who have sex with men, and sexually active teenagers
• sexual health should be combined with reproductive health services, for example in antenatal clinics, in order to reduce the stigma attached to STIs and provide broader access to treatment.

If STIs are to be effectively controlled, governments need to be convinced that controlling them in their own right is important – not only as a means to prevent HIV infection.

Source(s):
‘Global Control of Sexually Transmitted Infections’, Sexual and Reproductive Health 5, The Lancet 368, page 2001-2016, by Nicola Low, Nathalie Broutet, Yaw Adu-Sarkodie, Pelham Barton, Mazeda Hossain and Sarah Hawkes, 2006 Full document.

Funded by: UK National Institute for Health and Clinical Excellence (NICE)

id21 Research Highlight: 19 February 2008

Further Information:
Nicola Low
Department of Social and Preventive Medicine
University of Bern
Finkenhubelweg 11
Bern
CH-3012
Switzerland

Tel: +41 (0) 31 6313514
Fax: +41 (0) 31 6313520
Contact the contributor: low@ispm.unibe.ch

Department of Social and Preventive Medicine, University of Bern, Switzerland

Other related links:
‘Priorities for intervention: HIV, STIs and drug injecting in Central Asia’

‘New oral treatment proves effective against early syphilis in Tanzania’

‘Vouching for access: adolescent sexual health in Nicaragua’

‘End-of-term report on primary school sexual health programmes’