CONTENTS
Chapters
- The Toll of STDs
- Reducing the Toll of STDs
- Managing STDs
- Diagnostic and Treatment Tips
- Getting Services to the People
- Getting People to Services
- 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 |
Reducing the Toll of STDs
Timely and effective care for STDs can reduce their toll by
preventing transmission and sequelae. To provide care for the
most people, STD services need to be widely available. Several
steps are important:
- Adopting a quick, simple, and effective way to diagnose and
treat STDs. Microscopes and laboratory tests permit specific
diagnosis. Many health care providers in both developed and developing
countries lack equipment or time to await test results, however. They
manage STD patients by relying on symptoms (what the patient notices)
and easily observable signs (what the provider notices). Often STDs
can be identified by syndromes (groups of symptoms). The syndromic approach
to case management, now being promoted by the World Health Organization
(WHO), gives providers a systematic way to use this information (see
sidebar, The Syndromic Approach).
- Making effective services accessible. Most important is offering
STD services in primary health centers, which serve the most people.
The syndromic approach can help primary health care providers to diagnose
STD patients. At the same time, primary health care providers need help
and support from STD experts in district and provincial hospitals and
in national STD centers. Such support includes ensuring a steady supply
of drugs, training, managing difficult cases referred by the primary
care providers, and conducting surveillance of STD prevalence. Training
private providers also would help to make STD services more accessible
(see Chapter 5).
- Getting people with STDs to treatment. There are a variety
of approaches: mass-media communication to alert people and inform them
about STDs, screening people for STDs when they seek health care for
other reasons, notifying the sexual partners of STD patients that they
should seek treatment, and setting up special programs for high-risk
populations (see Chapter 6).
- Encouraging people to avoid STDs. People at risk need to use condoms and have
fewer sexual partners (see Chapter 7).
Effective and accessible STD service providers have made a difference in
STD control. For example, in Zambia the national STD program reduced the
number of new STD cases at University Teaching Hospital in Lusaka from about
18,000 in 1985 to about 5,000 in 1991 (290). The number of spontaneous abortions
due to syphilis during pregnancy also has declined. In Sweden providers
have helped to make gonorrhea a rare disease. In Nairobi an estimated 6,000
to 10,000 people have avoided HIV infection because of the work of an STD
prevention program (see Table 2). |