Sexually Transmitted Infections (STIs)

Important Points About Sexually Transmitted Infections (STIs).

More than a million sexually transmitted infections (STIs) occur every day worldwide, most of which are asymptomatic.

It is estimated that there are 374 million new infections each year due to one of four treatable sexually transmitted diseases: chlamydia, gonorrhoea, syphilis and trichomoniasis. It is estimated that more than 500 million people between the ages of 15 and 49 are infected with the genital herpes simplex virus (HSV or herpes) (1).

Human papillomavirus (HPV) infection is associated with over 311,000 cervical cancer deaths each year (2).

In 2016, it was estimated that nearly one million pregnant women were infected with syphilis, causing over 350,000 adverse birth complications (3).

STDs directly impact sexual and reproductive health through stigma, infertility, cancer and pregnancy complications and can increase the risk of HIV infection.

Drug resistance poses a major threat to reducing the burden of sexually transmitted diseases worldwide.

overview

More than 30 different bacteria, viruses and parasites are known to be transmitted through sexual contact, including vaginal, anal and oral sex. Some sexually transmitted diseases can also be passed from mother to child during pregnancy, childbirth and breastfeeding. Eight pathogens are associated with the highest incidence of sexually transmitted diseases. Four of these are currently curable: syphilis, gonorrhoea, chlamydia and trichomoniasis. The other four are incurable viral infections: hepatitis B, herpes simplex virus (HSV), HIV and human papillomavirus (HPV).

In addition, new infections such as monkeypox, Shigella monterei, Neisseria meningitidis, Ebola and Zika, as well as the recurrence of neglected sexually transmitted diseases such as lymphogranuloma venereum, can be transmitted through sexual contact. This indicates growing challenges in providing adequate services to prevent and control sexually transmitted diseases. Scope of the problem

sexually transmitted diseases have a significant impact on sexual and reproductive health worldwide.

More than a million sexually transmitted diseases occur every day. In 2020, WHO estimated 374 million new infections due to one of four sexually transmitted diseases: chlamydia (129 million), gonorrhoea (82 million), syphilis (7.1 million) and trichomoniasis (156 million). In 2016, it was estimated that more than 490 million people were affected by genital herpes and about 300 million women were infected with HPV, the leading cause of cervical and anal cancer in men. It is estimated that around 296 million people worldwide live with chronic hepatitis B.

STDs

can have serious consequences that go beyond the direct impact of the infection itself.

Sexually transmitted diseases such as herpes, gonorrhoea and syphilis can increase the risk of HIV infection.

Transmission of sexually transmitted diseases from mother to child can result in stillbirths, neonatal death, low birth weight and prematurity, sepsis, neonatal conjunctivitis and congenital malformations. HPV-

infection causes cervical cancer and other cancers. In 2019,

hepatitis B virus infections caused approximately 820,000 deaths, mainly due to liver cirrhosis and hepatocellular carcinoma.

If possible, condoms should be used during all vaginal and anal sexual intercourse. Safe and highly effective vaccines are available against two sexually transmitted viral diseases: hepatitis B and HPV. These vaccines represent a significant advance in the prevention of sexually transmitted diseases. By the end of 2020, the HPV vaccine had been introduced as part of routine vaccination programs in 111 countries, primarily high- and middle-income countries. To eliminate cervical cancer as a global public health problem, targets for widespread HPV vaccination, screening and treatment of precancerous lesions, and cancer treatments must be achieved by 2030 and maintained at these high levels for decades.

Research on genital herpes and HIV vaccines is well advanced and several vaccine candidates are in clinical development. There is increasing evidence that the meningitis vaccine (MenB) provides some cross-protection against gonorrhoea. Further research on vaccines against chlamydia, gonorrhoea, syphilis and trichomoniasis is needed.

Other biomedical interventions to prevent some sexually transmitted diseases include voluntary medical circumcision of adult men, microbicides, and partner treatments. Research is currently underway to evaluate the benefits of pre- and post-exposure STD prevention and its potential safety for antimicrobial resistance (AMR).

Diagnosis of sexually transmitted diseases STDs

are often asymptomatic. If symptoms occur, they may be non-specific. In addition, laboratory analyses are based on blood, urine and anatomical samples. Three anatomical sites can transmit at least one sexually transmitted disease. These differences are modulated by gender and sexual risk. These differences can mean that STDs often go undetected and people are often treated for two or more STDs.

Accurate diagnostic tests for sexually transmitted diseases (using molecular technology) are widely used in high-income countries. They are particularly useful in diagnosing asymptomatic infections. However, they are largely unavailable in low- and middle-income countries (LMICs) for chlamydia and gonorrhoea. Even in countries where they are available, tests are often expensive and inaccessible. In addition, waiting times for results are often long. As a result, further monitoring may be difficult and cure or treatment may be incomplete.

However, inexpensive rapid tests are available for syphilis, hepatitis B and HIV. The rapid syphilis test and the HIV/syphilis dual test are used in some resource-poor settings.

Numerous other rapid tests are in development and have the potential to improve the diagnosis and treatment of sexually transmitted diseases, particularly in resource-poor settings.

Treatment of sexually transmitted diseases

Effective treatments are now available for several sexually transmitted diseases.

Three bacterial diseases (chlamydia, gonorrhoea, and syphilis) and one sexually transmitted parasitic disease (trichomoniasis) can generally be treated with existing single-dose antibiotic therapies. In the case of herpes and HIV, antiviral drugs are the most effective drugs that can regulate the course of the disease, even if they cannot cure the disease.

For hepatitis B, antiviral medications can help fight the virus and slow liver damage. In recent years, antimicrobial resistance in sexually transmitted diseases – particularly gonorrhoea – has increased rapidly, limiting treatment options. The Gonococcal Antimicrobial Resistance Surveillance Program (GASP) has identified high rates of resistance to several antibiotics, including last-line quinolones, azithromycin, and extended-spectrum cephalosporins ( 4 ).

There is also resistance to other sexually transmitted diseases such as Mycoplasma genitalium, although less common.

STI case management

PRFIs rely on the identification of consistent, easily recognizable signs and symptoms to guide treatment without the need for laboratory testing. This approach – symptom management – ​​is often based on clinical algorithms and allows healthcare professionals to diagnose a specific infection based on the observed syndromes (e.g. vaginal/urethral discharge, anogenital ulcers, etc.).Treatment of the syndrome is simple, allowing rapid same-day treatment and avoiding expensive or unavailable diagnostic tests for symptomatic patients. However, this approach leads to over- or under-treatment, as most sexually transmitted diseases are asymptomatic. Therefore, WHO recommends that countries improve the management of disease syndromes by gradually introducing laboratory tests to support diagnosis. In facilities where quality-assured molecular testing is available, treatment of sexually transmitted diseases based on

laboratory tests is recommended. In addition, screening strategies for sexually transmitted diseases are essential for people at increased risk of infection, such as sex workers, men who have sex with men, and in some cases women, adolescents and pregnant women.

To interrupt transmission and prevent reinfection, treatment of sexual partners is an important part of STD treatment.

Diffusion control

Behavioural changes are complex

Despite significant efforts to identify simple interventions that can reduce risky sexual behaviour, behaviour change remains a complex challenge.

Information, education and advice can improve people's ability to recognize the symptoms of sexually transmitted diseases and increase the likelihood that they will seek treatment and encourage their sexual partners to do so. Unfortunately, a lack of public awareness, a lack of training among healthcare professionals, and the widespread and long-standing stigmatization of sexually transmitted diseases continue to pose barriers to broader and more effective use of these interventions.

Health services for testing and treatment of sexually transmitted diseases remain scarce

People who want to be tested and treated for sexually transmitted diseases face many problems. These include limited resources, stigma, poor quality of services and often out-of-pocket costs.

Some populations with the highest rates of sexually transmitted diseases – such as sex workers, men who have sex with men, people who inject drugs, prisoners, mobile populations and young people in countries with high HIV rates – often lack access to adequate services. and user-friendly healthcare services.

In many places, STI services are often overlooked and underfunded. These problems result in difficulties in screening for asymptomatic infections, inadequately trained personnel, limited laboratory capacity, and inadequate supplies of appropriate medications.

WHO response

Our work is currently guided by the global health sector strategy on HIV, hepatitis and sexually transmitted infections 2022-2030. In this regard, WHO has done the following:

develops global goals, norms, and standards for the prevention, testing, and treatment of sexually transmitted diseases;

supports estimating the economic burden of sexually transmitted diseases and strengthening sexually transmitted disease surveillance;

countries worldwide monitor antimicrobial resistance to gonorrhea; AND

advances the global STD research agenda, including the development of diagnostic tests, vaccines and additional drugs for gonorrhoea and syphilis.

As part of its mission, WHO supports countries to:

develops strategic plans and national policies;

create an encouraging environment in which people can discuss sexually transmitted diseases, practice safer sexual practices and seek treatment;

expand the scope of primary prevention (availability and use of condoms, etc.);

increase the availability of high-quality, person-centred STD care;

facilitates the introduction of point-of-care testing;

Strengthen and intensify effective health interventions such as hepatitis B and HPV vaccinations and syphilis screening in priority populations;

Strengthening capacity to monitor the development of sexually transmitted diseases; AND

monitors and responds to antimicrobial resistance in gonorrhoea patients. Organize a blog post, even if it paraphrases a few words, to increase the integration of STI services with primary health services;