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Sexually Transmitted Diseases, Vaccines, Prevention and Control.
  1. Rak Nandwani, Clinical Director
  1. Clinical Director, Genitourinary Medicine Services, The Sandyford Initiative, 6 Sandyford Place, Glasgow G3 7NB

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    Ed Stanberry LR, Bernstein DI. Pp 457; $119.95. New York: Academic Press, 2000. ISBN 0-12-663330-4.

    It has become increasingly clear that STIs cannot be controlled simply by diagnosis and treatment of the relevant pathogens alone. This new volume on STI prevention is especially relevant as we struggle to provide access for those already infected with sexually transmitted organisms. My first thought when I looked at this book was influenced by the cover illustration of a herpes simplex virion. It looked like another worthy tome about vaccine laboratory development spiced up with some phase I and II trial data. However, I am willing to admit that I have been pleasantly surprised by the clinical relevance of much of the book's contents, and that my initial prejudice was unjustified.

    The book consists of 18 chapters written by key authors from around the world, such as Lawrence Stanberry, Jonathan Zemilman, and Adrian Mindel who will be well known to readers of this journal. The chapters are divided into three sections dealing with epidemiology, physiology and immunology; non-specific strategies for control (such as behavioural interventions and barrier methods); and pathogens and vaccines. This final section makes up the meat of the book and comprises 11 chapters, which each provide an expert review on vaccine development for specific pathogens including herpes, HPV, hepatitis B, and chlamydia, as well as on gonorrhoea, syphilis and, of course, HIV. While it is inevitable that any book on this rapidly evolving subject will run the risk of becoming out of date, each author has attempted to ensure that relevant previous vaccine strategies and lessons learnt have been included. I felt this was particularly helpful as I believe that the book will be a valuable single reference source, even when the reviews of current vaccine development pass their “sell-by” date. For me, this is the justification in buying this book rather than saving a collection of journal articles.

    Highlights from the first two sections of the book included the chapter on vaginal microbicides which incorporated the International Working Group recommendations on development as part of an appendix. The first chapter on global epidemiology of STIs was particularly well written and referenced and includes a concise section on the HIV epidemic. I did however wonder why HHV-8/KSHV was omitted from such a comprehensive review. In a later chapter, I found the 13 or so pages on genital anatomy poorly illustrated and dispensable. I feel that the chapter on the Russian experience and the factors which led to the massive outbreak of syphilis should be compulsory reading for every sexual health clinician and public health specialist. It is too easy to ignore lessons from the past and from other settings.

    Stanberry and Bernstein's multiauthor volume provides a timely antidote to those important, but often dry, editions which are divorced from the realities of routine clinical practice. I feel able to recommend this book to the many of us who have endured tedious presentations and never quite got round to actually reading those articles on STI prevention and control which are gathering dust on desks, or worse still put away into filing cabinets “for later reference.” And one final plea to the publishers—could they find something a little more human to replace the cover electron micrograph? The whole point of this book is to review ways of ensuring that sexually transmitted pathogens do not gain the upper hand over their human hosts.