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Overview and Lessons Learned Program Examples Bibliography Links
Research Topics RTI Forum Glossary

Overview & Lessons Learned

The global disease burden of reproductive tract infections (RTIs), including sexually transmitted diseases (STDs), is a major public health concern.  Each year an estimated 333 million people are infected with a curable STD, such as gonorrhea (62.2 million), chlamydia (89.1 million), syphilis (12.2 million), and trichomoniasis (167.2 million).  Nearly one million new cases of curable STDs occur each day.  In 1995 there were 150 million new STD cases in south and southeast Asia (which represents nearly 46 percent of all new infections worldwide), 65 million in sub-Saharan Africa, and 36 million in Latin America and the Caribbean.

Click here for an overview of selected curable STDs from the WHO website(www.who.int/asd/figures/global_report.html).

STDs are a major source of morbidity among women and men in developing countries. After maternal causes, STDs are responsible for the greatest number of healthy years lost to developing country women of reproductive age. Prevalence patterns suggest that infections are more frequent among urban residents, unmarried individuals, and young adults. STDs are a serious health concern among adolescents (10-19 years) and young people worldwide; those aged 20-24 years face the greatest risk of infection. An estimated 5 percent of adolescents and young people contract an STD each year.

Serious long-term complications and sequelae of STDs in women, men, and newborns are well documented. They include pelvic infection, infertility, chronic pelvic pain, tubo-ovarian abscesses, and ectopic pregnancy in women and gonococcal eye infections and congenital syphilis in newborns. For more information, please refer to the STD Information Center section of the Journal of the American Medical Association website (www.ama-assn.org/special/std/). Women are more likely than men to suffer from STD complications and their complications are more likely to be severe, both for physiological and social reasons. In addition to health effects, STDs carry great social and economic consequences for individuals (particularly women), communities, and nations.

Research has shown that the presence of an STD, particularly ulcer-causing STDs, can enhance the acquisition and transmission of human immunodeficiency virus (HIV), which is the virus that causes acquired immune deficiency syndrome (AIDS). The presence of an STD has been estimated to increase HIV transmission by three to ten times.

Challenges to Controlling RTIs/STDs

Controlling RTIs/STDs in developing countries is complicated by:

  • lack of awareness of the problem of RTIs and their consequences;
  • limited and inaccessible health care services;
  • overburdened and undertrained health care workers;
  • competition with other important health problems for limited resources;
  • lack of screening or diagnostic tests;
  • limited access to appropriate treatment drugs;
  • difficulty in identifying and reaching infected persons, especially women who are often asymptomatic when infected; and
  • inability of women to influence the sexual behavior of men.

Rationales for Integration of RTI/STD Services

The emergence of HIV and the identification of STDs as risk factors for the spread of HIV have led to a reappraisal of current RTI/STD control approaches in recent years. While efforts to control STDs historically have targeted high-risk groups (e.g., commercial sex workers), recent infection patterns have shown surprisingly high infection rates among groups considered to be at low risk (e.g., women attending antenatal clinics). Moreover, STD control efforts mainly have focused on secondary prevention approaches, such as diagnosis and treatment delivered in specialized health facilities that may not be acceptable or easily accessible to those in need.

The integration of RTI/STD services with other existing health services and programs often is advocated as a strategy for providing client-centered approaches to RTI/STD services and reproductive health care. Rationales for an integrated approach include:

  • Better meeting clients' needs through increased access to reproductive health care.
  • Broader outreach to underserved groups, including adolescents and men, by offering a range of clinical and preventive health services at one site.
  • Improved efficiency and effectiveness by minimizing duplication of services, maximizing scarce resources, and sharing facilities and staff responsibilities.

Lessons Learned

Programs in developing countries have demonstrated that integrating of RTI/STD prevention and control with existing health programs and services is feasible. RTI/STD services can be integrated at every level of the health care delivery system, ranging from the national level to the provincial and district levels to the service-delivery level. Although RTI/STD services commonly have been integrated with family planning services and programs, they can also be integrated with maternal and child health care services, primary health care clinics, school health programs, and HIV/AIDS prevention and control programs.

Lessons learned from efforts to integrate RTI/STD services with other health services include:

  • It is important to involve all interested parties, including providers, staff, and community members, in the design and implementation of the integration framework.
  • Clear, standardized service protocols and guidelines help ensure successful implementation of services.
  • Training in counseling and interpersonal communication skills can help providers openly discuss reproductive health issues with clients.
  • Relying on clinical signs and symptoms for the diagnosis and treatment of RTIs, which is known as syndromic management, can be effective in resource-poor settings, although the sensitivity and specificity of some protocols in some settings is low.
  • Collaborating with other institutions and providers can reduce the human and financial costs of implementing integrated services.
  • Making effective drugs affordable and available at the peripheral level is important for the efficient management of STDs.
  • Notifying partners of infected men and women helps STD services to reach at-risk individuals and offers opportunities to provide focused STD/HIV education.
  • Providing appropriate family planning methods is an important element of any STD program that helps ensure the continuity of care and services. (See RHO Family Planning.)

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Overview and Lessons Learned Program Examples Bibliography Links
Research Topics RTI Forum Glossary