• sexually transmitted infections
• Africa

Prompt treatment of sexually transmitted infections (STIs) with effective antibiotic regimens, preferably contained in a single, supervised dose, is a cornerstone of STI control. The World Health Organization (WHO) revised its treatment guidelines in 2001.¹ A variety of regimens is proposed, from which national control programmes are encouraged to choose, depending on the susceptibility of local strains of Neisseria gonorrhoeae and Haemophilus ducreyi, and on the resources available to pay for treatment. WHO treatment guidelines reflect a tension between, on the one hand, the need to recommend the most effective single dose treatment and, on the other, the fact that this may not be available in many developing countries, especially in sub-Saharan Africa. Third generation cephalosporins, for example, have until recently been prohibitively expensive and, for that reason, are not included in the essential drugs list of some African countries. WHO guidelines have therefore included cheaper alternatives for the treatment of gonorrhoea, such as a 3 day course of co-trimoxazole, which are likely to be very much less efficacious. However, essential drug lists should respond to changing circumstances, and new drugs should be added when this is thought to be cost effective by groups of experts.

The price of many drugs has fallen dramatically in sub-Saharan Africa in recent years as a result of the development of a large generic drug industry in developing countries, such as India and China, and a vigorous campaign by WHO and NGOs, such as Médecins sans Frontières (MSF), for better accessibility to essential drugs.

Current prices and sources of a number of anti-infective drugs have been …