A Historical Review of Sexually Transmitted Infections

Sexually transmitted infections (STIs) have been present for centuries. In its fact sheet published in august 2016, the World Health Organization estimated that over 1 million STIs are acquired daily worldwide. Sexually transmitted infections, formerly referred to as sexually transmitted diseases (STDs) or venereal diseases (VD), are infections that are transmitted from one person to another majorly through sexual contact and genital contact, or through the use of unsterilized infected piercing objects, transfusion with infected blood, or from mother to child at childbirth. According to Aral, Over, Manhart et al. (2006), interest in STIs rose over the last two decades due to HIV epidemic. Earlier studies by Wasserheit (1989) and Laga, Diallo, and Buvé (1994) established that STIs cause an enormous burden in developing countries due to their role in mortality and morbidity and subsequent effects on reproductive, child health, and the transmission of HIV. According to Mayaud and Mabey (2004), between 75% and 85% of the estimated 340 million new cases of curable STIs (WHO, 2016) occur in developing countries, accounting for 17% of economic losses in ill health. However, the problem of STIs is not restricted to developing countries as Fenton and Lowndes (2004) established that STIs are a major public health concern in the Europe and other part of the world. In light of the developing trends, this paper offers a historical review of STIs in respect to control and treatment approaches and their comorbid role in the transmission of HIV.

Trends and Developments in STIs 

Sexually transmitted infections have profound impacts on sexual and reproductive health, a situation exacerbated by notable resistance by some of the infections such as gonorrhea to treatment (WHO, 2004). The figure of 1 million transmissions per day by WHO was determined a decade ago, and experts argue to be considerably higher today due to susceptibility of young adults and adolescents with expansive sexual practices. It is important that addressing the current predicament of STIs as a public health issue requires integrated and comprehensive approaches that take to account both existing and new intervention. The process requires critical examination of trends in STIs epidemiology and management to establish areas that need redress. However, the challenge lies in addressing the high number of STIs because they have different clinical manifestations and etiological factors, hence need different diagnosis, screening, treatment, and management approaches. Some commonly diagnosed STIs include:

Chlamydia

Chancroid

Crabs (Pubic Lice)

Genital herpes

Genital warts

Hepatitis B

HIV/AIDS

Human Papillomavirus (HPV)

Trichomoniasis (parasitic infection)

Molluscum Contagiosum

Pelvic Inflammatory Disease (PID)

Scabies

Syphilis

Syphilis, gonorrhea

Trichomoniasis (Trich)

Yeast infections

There is a consensus that rates of transmission of STIs are on the rise, notably among the youth aged 15-25 years (WHO, 2016). According to Gilson and Mindel (2001), the solution to this problem remains elusive despite the development of new test that offer screening opportunities for common STIs such as Chlamydia trachomatis, herpes simplex virus, and human papillomavirus. However, the application of such tests remains highly restricted to research as their transition to clinical practices raises a number of ethical and economic issues in the management of STIs (Aral, Over, Manhart et al. , 2006; Gilson & Mindel, 2001), a similar predicament that faces treatment options available for these conditions. According to Aral, Over, and Manhart et al. (2006) an interactive evolution has been witnessed in STIs’ epidemiology and management since 1993. Wasserheit and Aral (1996) attributed the changes to technological advances in screening, diagnosis, and treatment; evaluation and extensive implementation of novel management algorithms; and the shift in risk behaviors in response to HIV epidemic.

However, Mayaud and Mabey (2004) argued that the challenge is not in developing new approaches but rather making the existing ones effective, a perspective driven by new found evidence of the important role of STIs control in reducing HIV transmission (Laga, M., Diallo, & Buve, 1994; WHO, 2016). According to Mayaud and Mabey (2004) primary prevention through dissemination of information, public education and communication drives, promotion of condom use, vaccination, and use of microbicides; screening for STIs cases among vulnerable populations; case management through syndromic approach; targeted intervention; and targeted periodic mass treatment; are traditional approaches that can be employed with success. Therefore, focus should be on identification of barriers to approaches that work rather than investing in new intervention measures. For instance, antibiotic use, which is unregulated in most developing countries (Aral, Over, Manhart et al. , 2006), causes misuse and overuse and subsequent drug resistance by some species such as Neisseria gonorrhoeae . According to Hart and Kariuki (1996), drug resistance is the leading cause of morbidity and mortality from infectious diseases. STIs are infectious diseases and with over 75% of them occurring in the developing world (Mayaud & Mabey, 2004; WHO, 2016), it justifies the case for devising ways of reducing practices that lead to resistance rather than focusing on new interventions that are inapplicable to such settings due to ethical and economic reasons. There is need to recognize the role of social and cultural factors in the prevalence of STIs in different communities to facilitate development of targeted approaches.

Conclusion 

Sexually transmitted infections have been an existing problem for centuries, and though they are a public issue worldwide, their effects are exacerbated in developing countries due to lack of effective management approaches. However, there has been a paradigm shift in attention given to STIs, majorly due to its role in the transmission of HIV and the developing antimicrobial drug resistance. These are problems facing the entire world and cannot be left to developing countries to tackle. The understanding has sparked an array of efforts in research and funding towards the development of new intervention measures, but the challenge lies in their adoption in clinical practice due to ethical and economic challenges. Under the context, it is important to examine traditional approaches, identify barriers to them, and eliminate them to for desirable outcomes to be realized.

References

Aral, S. O., Over, M., Manhart, L., & Holmes, K. K. (2006). Sexually transmitted infections in Disease control priorities in developing countries . 2nd edition.

Fenton, K. A., & Lowndes, C. M. (2004). Recent trends in the epidemiology of sexually transmitted infections in the European Union.  Sexually transmitted infections ,  80 (4), 255-263.

Gilson, R. J., & Mindel, A. (2001). Sexually transmitted infections.  BMJ: British Medical Journal ,  322 (7295), 1160.

Hart, C. A., & Kariuki, S. (1998). Antimicrobial resistance in developing countries. British Medical Journal, 317(7159), 647–50. 

Laga, M., Diallo, M. O., & Buve, A. (1994). Interrelationship of sexually transmitted diseases and HIV: where are we now? AIDS, 8, 119–24.

Mayaud, P., & Mabey, D. (2004). Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges.  Sexually transmitted infections ,  80 (3), 174-182.

Wasserheit, J. N. (1989). The significance and scope of reproductive tract infections among Third World women.  International Journal of Gynecology & Obstetrics ,  30 , 145-168.

Wasserheit, J. N., & Aral, S. O. (1996). The dynamic topology of sexually transmitted disease epidemics: implications for prevention strategies.  Journal of Infectious Diseases ,  174 (Supplement 2), S201-S213.

WHO. (2016, August). Sexually transmitted infections (STIs). Retrieved 20/03/ 2017 from: http://www.who.int/mediacentre/factsheets/fs110/en/.