Sexually Transmitted Infections

STIs: Overlooked and Under-treated

The Most Common STIs
  • Human Papillomavirus (HPV)
    • loss of 3.3 million disability-adjusted life years (DALYs) each year
    • cause of almost all cervical cancer
  • Syphilis
    • loss of 4.2 million DALYs each year
    • cause of stillbirth, prematurity, and death
  • Chlamydia & Gonorrhea
    • loss of 7 million DALYs each year
    • cause of infertility and fatal ectopic pregnancy

With the exception of HIV-AIDS, sexually transmitted infections (STIs) have received little attention since the 1990s. However, the impact of these infections continues to be significant. Experts site stigmatization as the main reason why efforts to control these infections fail worldwide.

Most common STIs can be prevented with condom use. Almost all of them can be cured (bacterial and protozoan) or kept in remission (viral infections) with simple antimicrobial medications. Unfortunately, effective antibiotics and diagnostic tests are not readily available in many poor countries. Although most of these medicines are easy to manufacture, the pharmaceutical lobby and World Trade Organization (WTO) make low-cost production of generics difficult. The two promising STI vaccines, for Hepatitis B and HPV, are unlikely to be available in developing settings for many years.

Private Sector and STI Treatment

Social marketing programs have been the most effective at addressing stigma and promoting service availability for STI treatment. Where clinical services are necessary, social franchise organizations have been the main venue for STI treatment services. Voucher schemes have been helpful in targeting high-risk groups in developing settings (e.g., sex workers and truck drivers).

Strengths

  • STI treatment is amenable to voucher-based OBA
  • Accessibility
  • Anonymity
  • Many effective medicines appropriate for STI care

Weaknesses

  • Cultural constraints on STIs and STI care
  • Lack of funding; diversion to HIV/AIDS
  • Social stigma
  • WTO restrictions on generic medicines
  • Low volume and low profit service
  • Requires lab diagnosis for most STIs