y Chapter 1.1: The Extent of STDs, Population Reports, Series L, Number 9

CONTENTS

          Chapters
  1. The Toll of STDs
  2. Reducing the Toll of STDs
  3. Managing STDs
  4. Diagnostic and Treatment Tips
  5. Getting Services to the People
  6. Getting People to Services
  7. Promoting Prevention—Condoms and Monogamy

HIGHLIGHTS

Population Reports is published by the Population Information Program, Center for Communication Programs, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202-4012, USA


Volume XXI, Number 1
June, 1993

The Extent of STDs

 The high incidence of STDs among women attending antenatal, family planning, or gynecological clinics indicates the extent of the STD problem. For example, in studies in developing countries up to 18% of these patients have gonorrhea, up to 17% have syphilis, and up to 30% have trichomoniasis (see table in appendix).

Sexually transmitted diseases are a major public health problem in both developed and developing countries, but prevalence rates apparently are far higher in developing countries, where STD treatment is less accessible. Among women, syphilis prevalence rates may be 10 to 100 times higher in developing countries; gonorrhea rates may be 10 to 15 times higher; and chlamydia rates may be 2 to 3 times higher (315). Incidence rates also are higher. For example, the annual rate of new gonorrhea infections in large African cities is 3,000 to 10,000 per 100,000 population, or as many as one in every 10 people. By comparison, in the US the annual incidence of gonorrhea was 233 per 100,000 population in 1991, and in Sweden, about 30 per 100,000 in 1987 (11, 68, 305).

Among developing regions STDs appear to be more common in Africa than in Asia or Latin America. In a review by Judith Wasserheit, a median of 20% of women attending family planning, antenatal, or other clinics in Africa had trichomoniasis, for example, while the median prevalence in Asian studies was 11%, and in Latin American studies, 12% (313).

Youth have high rates of STDs (28, 73, 101, 174, 212, 307, 326). In a study at Kenyatta National Hospital in Nairobi, for example, 23% of women ages 15 to 19 seeking antenatal care had gonorrhea, chlamydia, or herpes (174). In the US women ages 15 to 19 have the highest incidence of gonorrhea, and men ages 15 to 19 have the second highest incidence of any age group (305).

In many countries clinic surveys are the best available indicators of STD levels. The true extent of STDs in the general population remains unknown for several reasons:

  • Both men and women may suffer from asymptomatic STDs, but women more so than men. For example, 70% of women and 30% of men infected with chlamydia may be asymptomatic as well as 30% of women and 5% of men infected with gonorrhea (132, 309).
  • Many people with STDs do not seek care, and in developing countries people are not routinely screened for STDs when they seek other health care.
  • Because of the stigma attached to STDs, many people seek care from providers who do not report cases.
  • Some governments are reluctant to admit to a high prevalence of STDs. The AIDS epidemic is beginning to change this attitude, however.
Up to 10% of reproductive-age adults are infected with an STD each year.
The few studies in developing countries report mixed trends. For example, between 1987 and 1991 in 15 of 21 Latin American countries, the incidence of gonorrhea decreased, while in 12 countries the incidence of primary, secondary, or congenital syphilis increased (338).

Evidence from developed countries also shows mixed trends. The incidence of chlamydia is increasing in North America and some European countries (282). Chancroid and primary syphilis are becoming more common in the US (97, 270). In contrast, the incidence of gonorrhea has been decreasing in Canada, Sweden, the UK, and the US, and the incidence of primary syphilis has decreased in Sweden (11).


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