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Sexually transmitted infections, HIV/AIDS - Training Course in Sexual and Reproductive Health Research 2014

GFMER - Sexually transmitted infections

Antonio Carlos Gerbase

Antonio Carlos Gerbase - Director of GFMER HIV/AIDS and other Sexually Transmitted Infections Program

Sexually transmitted infections: a global burden for individuals and societies

Sexually transmitted infections (STI) are a major public health problem in developing as well as developed countries. The significant morbidity and mortality due to STI as well as the fact that STI disproportionately affect women and sexual minorities (men who have sex with men, transgender etc) necessitate the particular attention of health service policy makers.

It is hard to estimate the global burden of STI because of asymptomatic infections, the absence of diagnostic tools, and a weak system of surveillance for STI in many countries.

According to 2008 WHO estimates, around 500 million new cases of curable STIs (syphilis, gonorrhoea, chlamydia and trichomoniasis) occur annually throughout the world in adults aged 15-49 years. Most STI tools and interventions have been available for years. In spite of these facts STIs are not getting the deserved public health attention and action.

Gonorrhoea resistance is a permanent threat to STI control. See Emergence of multi-drug resistant Neisseria gonorrhoeae - Threat of global rise in untreatable sexually transmitted infections. Fact sheet, World Health Organization, Department of Reproductive Health and Research

It is important to know that all STI are preventable and most can be cured. Effective STI case management is the basis of sexually transmitted infections control. An appropriate clinical algorithm can break the chain of transmission from infected to non-infected persons.

Present challenges in STI prevention and care include:

  • The need to improve country and global data on STIs
  • Elimination of Congenital Syphilis
  • New STI case management strategies including new diagnostic tests and updated syndromic management
  • HPV and HBV vaccination
  • Control of gonorrhoea resistance

See The importance of a renewed commitment to STI prevention and control in achieving global sexual and reproductive health. WHO, 2013.

GFMER activities lines in STI

Partnerships

  • Liaison with WHO, UNAIDS and other key strengthening and fostering partnerships and discussing potential joint activities. Support to STI agencies’ activities.

Technical Assistance

  • Proactively dissemination of updated technical information in HIV/AIDS/STI and to promptly response to HIV/AIDS/STI related questions received from partners and Foundation members. Support to development of National STI guidelines and strategies.

Capacity building

  • STI module of the Training Course in Sexual and Reproductive Health.
  • Short online course on STIs.

Innovation

  • “STI Think Tank” with key high-level partners to discuss barriers, opportunities and new strategies, including use of new diagnostic tests, for STI prevention and care.

Selected online documents and resources

Guidelines for management of STIs, 2003 to 2013

WHO STI Strategic Documents

  • Reproductive health and STI
  • Sexually transmitted diseases: policies and principles for prevention and care UNAIDS best practice collection. Key material, Authors: UNAIDS, WHO
    http://www.who.int/reproductivehealth/publications/rtis/UNAIDS_97_6/en/index.html
    A comprehensive document written in 1994 1995. Touches all aspects of prevention and care. Emphasis in Syndromic approach. A good Policy guide for countries, in many aspects still valid. Needs update in new developments such as HPV vaccine, new diagnostic tests and discuss alternatives for the low specificity of some syndromic approach flowcharts (e.g. cervical infection).
  • Sexually transmitted and other reproductive tract infections, A guide to essential practice, Authors: World Health Organization, Department of Reproductive Health and Research
    http://www.who.int/reproductivehealth/publications/rtis/9241592656/en/
    It is a comprehensive implementation tool directed to programme managers. It is based in the Policies and Principles document and in the outdated, and not available in WHO web site, Treatment guidelines. Very well evaluated by users in the recent RH evaluation.
  • Global strategy for the prevention and control of sexually transmitted infections: 2006-2015. Authors: World Health Organization, Department of Reproductive Health and Research – Key Messages
    http://www.who.int/reproductivehealth/publications/rtis/RHR_06_10/en/index.html
    A summary of the Global strategy for the prevention and control of sexually transmitted infections: 2006 - 2015. Breaking the chain of transmission, Authors: World Health Organization, Department of Reproductive Health and Research.
  • Global control of sexually transmitted infections. The Lancet Sexual & reproductive health series, Authors: Low, N, Broutet, N, Adu-Sarkodie, Y, Barton, P, Hossain, M, Hawkes
    A good discussion paper on global STI control. Again comprehensive with many key actions. Shorter than the strategy.
  • Global strategy for the prevention and control of sexually transmitted infections: 2006 - 2015. Breaking the chain of transmission, Authors: World Health Organization, Department of Reproductive Health and Research
    http://www.who.int/reproductivehealth/publications/rtis/9789241563475/en/index.html
    It is the strategy one use. Reviews STI burden. The purpose is mainly to provide a framework for action. Has a technical and advocacy component. Comprehensive, with many recommendations and, for this reason found difficult to promote. There are priorities for immediate action. Both technical and advocacy components need to be evaluated as soon as possible (2014) as the strategy covers 2009-2015.
  • WHO’s strategic vision in sexual and reproductive health and rights Business Plan 2010–2015, Authors: Department of Reproductive Health and Research (RHR)
    http://www.who.int/reproductivehealth/publications/reports/rhr_10_10/en/
  • Revitalizing the National STI/RTI Control Activities in Kenya, Report of a high level Consultative meeting, Authors: WHO, UNFPA, Population Council, CDC
    http://www.who.int/reproductivehealth/publications/rtis/report_kenya/en/
    It is a country exercise linking the country current activities with international experience and local pilot projects. Recommendations were made to the national authorities.
    This kind of exercise implies in emphasis of TA in evaluation, planning and technical support to implementation of national STI activities/programmes.
  • Introducing and pilot-testing the national guidelines on integrating the management of. STIs/RTIs into reproductive health settings in Kenya. Authors: Division of Reproductive Health, Ministry of Health, Kenya - National AIDS and STD Control Programme (NASCOP), Kenya - The Population Council
    http://www.who.int/reproductivehealth/publications/rtis/management_rtis_stis/en/index.html
    The document summarizes a national experience in implementing RTI/STI guidelines. The activity is a mix of TA, M&E and OR linked to guidelines utilization.
    Implies in staff involved in TA, operational research, M&E of national programmes and documentation of best practices.
  • Investment case for eliminating mother-to-child transmission of syphilis. Promoting better maternal and child health and stronger health systems. Authors: WHO, Dept. of Reproductive Health and Research
    http://www.who.int/reproductivehealth/publications/rtis/9789241504348/en/index.html
    The document advocates and describes the main strategies to elimination of mother-to-child transmission of syphilis.
  • Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy. A demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania, and Zambia. Authors: African Population and Health Research Center, International Agency for Research on Cancer, World Health Organization
    http://www.who.int/reproductivehealth/publications/cancers/9789241503860/en/index.html
    A demonstration project of visual inspection with acetic acid (VIA) cryotherapy incorporated into the cervical cancer-prevention services in existing reproductive health services in six countries.
  • Sexually Transmitted Infections (STIs), The importance of a renewed commitment to STI prevention and control in achieving global sexual and reproductive health. Authors: WHO
    http://www.who.int/reproductivehealth/publications/rtis/rhr13_02/en/index.html
    An advocacy document categorizing key points for action: scaling up of services, advocacy for interventions, new technologies development.
    Existing tools: STI case management, counselling and behaviour interventions, diagnostic tests, antimicrobials, vaccines and microbicides.
    Action agenda: scaling up of services, prevention promotion.
    New technologies: tests, vaccines new drugs. Some superimposition of activities and somehow artificial grouping.

WHO STI Technical Documents

Key populations

eMTCT

UN Agencies

Aid Agencies

GFMER documents