Sexually transmitted diseases (STDs) are a major public health problem now compounded by the advent of AIDS and HIV infection. The size of the problem represented by STDs and HIV is unknown however it is estimated that there are 333 million new cases of STD per annum and currently 15-20 million people infected worldwide with HIV. Control programmes for STDs must prevent the acquisition of STDs, their complications and sequelae and interrupt and reduce transmission. They can also reduce the incidence of HIV infection. Such programmes must place emphasis on health education, condom usage, altering health seeking behaviour and providing case management. The syndromic approach currently offers the most realistic, and cost effective, way in which to treat patients.
PIP: An integrated STD (sexually transmitted disease) and HIV control program is vital to tackling the major public health problem of STDs and HIV/AIDS. The World Health Organization estimates that there are 333 million new STD infections and 15-20 million new HIV infections each year. The two basic principles common to all STD control programs worldwide include prevention of STDs, their complications, and sequelae and the interruption and reduction of their transmission. These principles also apply to bringing about the reduction of the incidence of HIV infection. Primary prevention strategies, which should be accessible to all sexually active adults and youth, include health education and information, education, and communication (IEC). Secondary prevention strategies include promotion of health care seeking behavior, case management of people with an STD, and early detection and treatment of asymptomatic infections through case finding and screening. In developing countries especially, the most realistic and cost effective way to treat STD patients is the syndromic approach. This approach uses algorithms based on common signs and symptoms (e.g., genital ulcer, urethral and vaginal discharge). It can be used either with or in the absence of laboratory support. The two most common causes for genital discharge are syphilis and chancroid, so, given no laboratory support, the health provider would provide treatment for both STDs. The algorithm for urethral discharge is similarly clear cut. That for vaginal discharge is not so discriminating, since this symptom is very common and non-specific with multiple non-sexually acquired etiologies possible. Since most chlamydial and gonococcal infections in women are asymptomatic, active case finding, screening, and partner notification are very important in women-focused STD control programs.