April 1997 Insights Issue #22

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STIs prevalence and morbidity:
the global situation

Sexually Transmitted Infections have a major demographic, economic, social and political impact, particularly in sub-Saharan Africa and increasingly in Asia.

• estimated new cases of curable STIs among adults in 1995 were 36 million in Latin America, 9.7 in North Africa and the Middle East, 65 million in sub-Saharan Africa, 150 million in South and South East Asia, and 23 million in East Asia and the Pacific.
• STIs (excluding HIV) are the second cause (after maternal morbidity and mortality) of healthy life lost among women aged 15+44 years.
• STIs are important because of their social stigma and medical complications. In sub-Saharan Africa 50% of cases of infertility, a personal and family tragedy, can be traced to STIs. They can have long-term effects such as chronic pain, ectopic pregnancies, puerperal sepsis, cervical cancer and damage to the foetus and new born child. The presence of STIs increases the risk of HIV transmission by a factor of three to five. The risk of HIV infection from a single exposure is increased 10+300 fold in the presence of a genital ulcer.
• 16%, chlamydia trachomatis 25% and syphilis 23+32%). Commercial sex is a main transmission route for STIs in many developing countries.
• levels of STIs are also high among the general population; they are measured by prevalence among women attending ante-natal clinics or by community surveys. The highest rates are reported in Africa. For instance, a survey of adolescent girls (17 years or less) in a rural community in Nigeria showed that 50% were sexually active of whom 19.4% had bacterial STIs or trichomoniasis infection.
• world-wide, it is estimated that 70% of STI patients are in the 15+24 year age bracket but adolescents are less likely to attend for treatment.
• only a tiny fraction of those with an STI are currently treated in developing countries, partly because many STIs are asymptomatic in both men and women. Strategies for reducing the transmission of STIs require intervention at a number of levels, drawing upon both medical and health promotion activities, to prevent new infections, treat those with symptoms of infection, identify and treat those without symptoms and provide those who may know they are infected with better access to services and motivate them to attend earlier by providing effective treatment in a non- stigmatising, non-judgmental setting.

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