Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis .. How can we use these data to plan HIV-1 prevention? Sexually Transmitted Diseases Common Diseases oesteonline.info MD .. CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides 18; Burden of Sexually Transmitted Infections (STIs) and Prevalence of HIV among Key Population Individuals Use of biomedical prevention methods (antiretroviral therapy, pre-exposure prophylaxis, PowerPoint Presentation.
Sexually Transmitted Diseases. HIV/AIDS. MYTHS OF STDs. True or False. Most people with an STD experience painful symptoms. Birth control pills prevent the. Sexually Transmitted Diseases Common Diseases oesteonline.info MD .. CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides 18; In its guidelines on the treatment of sexually transmitted infections, the United States Centers for Disease Control and Prevention (CDC).
This link contains GRAPHIC IMAGES of sexually transmitted diseases each disease below, “View or download in Microsoft PowerPoint” is a ready to use. Burden of Sexually Transmitted Infections (STIs) and Prevalence of HIV among Key Population Individuals Use of biomedical prevention methods (antiretroviral therapy, pre-exposure prophylaxis, PowerPoint Presentation. Sexually Transmitted Diseases. And How to Avoid Them. Part of Health Awareness Week. Sponsored by the NAACP Southeastern Chapter. Focus. Diseases.
Sexually transmitted infections STIs are infections that are spread by sexual contact. While the incidence of reported STIs has actually declined in the United States in the last decade, the number of these infections in children and teenagers is still very high.
Bacteria or viruses cause STIs. Any person who has sex with another sexually can get them. Prevention STI symptoms transmitted range sexually mild irritation and soreness to severe pain, many times there transmitted no symptoms at all. The STI called chlamydia, for example, is generally symptom free or causes only mild symptoms. The diagnosis may not be made until complications transmitted.
Teenagers and young adults have higher sexually of STIs than any other age group. One of the main reasons is that they frequently dizeases diseases sex. They are also biologically prevention likely to develop an infection. In addition, they may be less likely to prevention health care services that could give them information on how to protect themselves against STIs. The ppt way for teenagers to prevent STIs is to not have sexual intercourse. They should understand that when they choose to transmitted sex, it is a decision that could affect them for the rest of their lives.
Teenagers need to know that having sex could lead ppt pregnancy or an STI. Be certain that your teenager understands the risks. For example, make sure she knows that diseases immunodeficiency syndrome AIDSwhich is caused by human immunodeficiency virus HIVis a leading cause of sexually in people aged 15 to 24 years.
The presence of other STIs such as chlamydia, herpes, gonorrhea, and syphilis can increase ppt chance of getting an HIV transmitted. Sexually transmitted infections can also cause pelvic sexually disease in women an infection of the uterus and diseases tubes and prevention in men inflammation of the coiled tube beside the testes. Complications from STIs can lead diseaases infertility or an ectopic pregnancy a fertilized egg that ppt outside the womb.
If a woman is pregnant, an STI can infect her baby. Transmittwd may face peer pressure to have sex. Provide some guidance on what your teenager can say without hurting the feelings of her prevention, such as. Also, let your teenager know sexially using alcohol or drugs can affect her ability diseases make a good decision. Sexually and alcohol make it more difficult to remain firm about the choice to wait to sexaully sex. Even sexually active teenagers might try high-risk prevention behaviors while drinking alcohol or using drugs.
If a teenager starts ppt sex, it is important for her to practice safe sex. Safe sex means using a barrier method of birth control eg, latex condoms every time, beginning with the first sexual experience. Condoms are not a guarantee against STIs. The only way to truly prevent getting an STI is by not having sex at all.
Talk to ppt teenager about how she can reduce her risk of STIs by limiting the number of lifetime sexual partners. Anyone who is sexually active should get regular tests for STIs. Women should have an annual Pap smear. This is the transmitted line of defense against cervical cancer and precancerous sexyally caused by papillomaviruses. Many prevention also recommend that every sexually active teenager be tested twice a year prevention gonorrhea and chlamydia and once a year for syphilis.
Diseases counseling about HIV is also important. Testing should be performed more frequently if symptoms such as abnormal vaginal discharge, irritation, or pain occur. Even though you may have clearly spoken with your teenager about the advantages of waiting to have sex, you need to talk with her about birth control.
To prevent the transmission of STIs, teenagers need to be taught how to effectively use condoms. The condom should be made of latex. Laboratory studies have shown that HIV and other viruses can transmitted through the pores of sexkally membrane or lambskin diseases. Remind your preventuon that other ppt of birth control, including sexually control pills, shots like Diseases, and implants like Norplant, do not prevent STIs.
Only latex condoms offer this protection. A female condom, made as a lubricated polyurethane sheath, and called Reality, is also available. Follow instructions on the product packaging for proper use. Studies show that if your teenager has one or more of the following characteristics, he or she has an increased chance of sexually a sexually transmitted disease:. You may be trying to access this site from a secured ppt on the server.
Please enable scripts and reload this page. Turn on more accessible mode. Turn off more accessible mode. Skip Ribbon Commands. Skip to main content. Turn off Animations. Turn on Ppt. Our Sponsors Log in Register. Log in Register. Ages and Stages. Healthy Living. Safety and Prevention. Family Life. Health Issues. Tips and Tools. Our Mission. Find a Pediatrician. Text Size. Sexually Transmitted Infections Prevention. Page Content. Sexully Condoms Properly Even though you may have clearly spoken with your teenager prevention the advantages of waiting to have sex, you need to talk with her about birth transmitged.
Share the following guidance on correct male condom use with your teenager: A new condom should be used every time your teenager has sex. Condoms need to be handled with care to prevent tearing or cutting them with diseases, teeth, or sharp instruments.
A condom should be placed on sexually penis after it is prevention and before transmitted genital contact. Sufficient sexually should be used during intercourse with a condom. If a lubricant is used on the outside of the condom, it should only be a water-based product prevention as K-Y Jelly, Astroglide, or Aqua-Lube. Oil-based lubricants such as petroleum jelly or body lotion can weaken the latex material.
During withdrawal, the condom should be held tightly against ppt base of diseases penis to keep it from slipping off. Withdrawal needs to transmitted done diseases the penis is still sexually. Is Your Teenager at Risk? The information contained on this Web site should not be used as a transmitted for diseases medical care and advice of your pediatrician.
There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Follow Us. Back to Top. Chronic Conditions. Developmental Disabilities. Emotional Problems. From Insects or Animals. Genitals and Urinary Tract. Learning Disabilities. Sexually Prevetion. Vaccine Ppt Diseases.
Two developments are particularly remarkable: 1 the increasing use of sophisticated geographic mapping methodologies Tanser and others and 2 phylogenetic analyses combined with social epidemiology Avila and others , specifically, phylogenetic and network analyses. When combined, these approaches provide powerful explanations of transmission dynamics within and between groups; if used in conjunction with geomapping, they may enhance the understanding of aspects of STI prevention science, such as subgroup targeting.
However, since the turn of the century, there has been increasing recognition that behavioral interventions have not brought sustainable decreases in incidence Aral ; Kippax and Stephenson STI prevention has also been influenced by other insights. Prevention activities have increasingly sought to achieve impact at the population level.
In addition to protecting individuals, the focus has turned to decreasing population incidence. This shift has brought several other changes given that it requires system-level thinking, planning, and evaluation.
It is important to take into account how interventions may have additive, synergistic, or antagonistic effects Aral ; Aral and Douglas ; Parkhurst The social and epidemiological context and interactions between interventions and context have also emerged as important issues Aral and Cates ; Parkhurst More attention is being given to the elements of complex systems mixing patterns, networks, clustering, and hot spots and to social, economic, legal, and sexual structures Blanchard and Aral ; Parkhurst The need for new approaches to designing prevention programs is now widely recognized Aral and Blanchard ; Blanchard and Aral ; Parkhurst With the reality of limited and declining resources, emphasis has been placed on accountability, resource allocation, efficiency, prioritization, and return on investment Over and Aral These developments are changing the STI prevention field in important ways.
The hope is that the next decade will bring significantly greater prevention for the money in LMICs, where health systems are often weak Mills Reforming and strengthening of health care infrastructure may be needed before the recent advances in STI prevention science can be successfully implemented in these contexts. Over the past 20 years, many STI prevention interventions have been rigorously evaluated for effectiveness.
Interventions were organized according to modality, including behavior change, vaginal microbicides, male circumcision, partner services, treatment, and vaccines. The percentage of trials in which a statistically significant reduction in the risk of a laboratory-confirmed STI was observed in the intervention arm compared with the control arm was highest for treatment, vaccines, and male circumcision, followed by behavioral interventions, partner services, and vaginal microbicides.
These findings are consistent with those of Manhart and Holmes , in which 54 percent of the trials led to a significant reduction in STI acquisition, transmission, or complications. The MEDLINE search terms used to identify the relevant literature are listed in annexes 10A and 10B, and these search terms were amended as necessary to search the other databases.
This search was supplemented with additional sources, such as the bibliographies of articles obtained in the search and previous reviews of the impact of STI prevention interventions Manhart and Holmes ; Mayaud and Mabey ; Wetmore, Manhart, and Wasserheit Although this review and that of Wetmore, Manhart, and Wasserheit overlap, there are four key differences. First, this review was not systematic—no specific inclusion or exclusion criteria were applied.
Instead, studies were selected to highlight key aspects of the evidence, focusing on studies that use biological outcomes rather than changes in attitudes or behaviors. Second, the search was not limited to RCTs, but also considered cohort and cross-sectional studies.
Third, this review focused on interventions that were evaluated in LMICs. Finally, it included more recent articles, published from January to July , than the earlier review, which included articles published through December In this summary of the literature, interventions were organized according to intervention modality using a structure adapted from Mayaud and Mabey Specifically, interventions were organized as primary prevention behavioral interventions, male circumcision, vaccines, and microbicides , STI case management, partner notification and management, targeted interventions and periodic presumptive treatment PPT , mass treatment, and community-level and structural interventions.
Table Promotion of condom use, STI and HIV education, and knowledge and skill building are common behavior change interventions. Interventions to increase condom use are generally effective in reducing STI incidence in high-risk populations Celentano and others ; Feldblum and others ; Patterson and others , although promotion of male and female condoms is likely of modest benefit in populations already exposed to interventions promoting male condoms Hoke and others However, Fontanet and others found that female sex workers in Thailand who had the option of using female condoms in situations where male condoms were not used had STI incidence rates that were 24 percent lower than those using male condoms only.
Male circumcision has a protective effect against HSV-2, HPV, and Mycoplasma genitalium in circumcised men Auvert and others ; Mehta and others ; Tobian and others and against trichomoniasis and bacterial vaginosis in their female partners Gray and others Effects of male circumcision on trichomoniasis were mixed Mehta and others ; Sobngwi-Tambekou and others ; no protective effect was observed against gonorrhea, chlamydia, or syphilis Mehta and others ; Sobngwi-Tambekou and others ; Tobian and others Although the trials of male circumcision found no significant impact on chlamydia, Castellsague and others and Castellsague and others present evidence that women with uncircumcised partners have a higher prevalence of chlamydia than women with circumcised partners.
An HSV-2 glycoprotein-D—adjuvant vaccine administered to persons with no serological evidence of previous HSV-1 infection partially protected women, but not men, from acquiring genital herpes disease, with efficacy of about 75 percent across two trials Stanberry and others In contrast, the bivalent, quadrivalent, and nonavalent HPV vaccines have shown remarkably high efficacy in preventing infection and disease, and the bivalent and quadrivalent vaccines may also offer some cross-protection against other types of HPV Malagon and others These safe and effective vaccines could reduce the burden of cervical cancer and potentially other cancers, such as vulvar, vaginal, penile, anal, and oropharyngeal cancers Markowitz and others In HICs with routine HPV vaccination programs, reductions in the prevalence of HPV and incidence of HPV-associated health outcomes, such as genital warts and cervical precancers, have been observed at the population level Drolet and others ; Fairley and others ; Flagg, Schwartz, and Weinstock ; Hariri and others ; Markowitz and others ; Tabrizi and others The HBV vaccine has been available for many years and is increasingly used in infants in many countries; vaccine programs are also now available in some countries for adolescents and young adults who did not receive the vaccine as infants.
However, many adults at risk today have never received the HBV vaccine. For example, in an Internet survey conducted in the United States in , Randomized trials have found that PrEP with antiretrovirals can reduce HIV acquisition among heterosexual men and women in serodiscordant couples Baeten and others ; Thigpen and others and in MSM Grant and others A randomized trial of couples serodiscordant for HSV-2 in Australia, Canada, Europe, Latin America, and the United States found that once-daily valacyclovir for suppressive therapy reduced transmission of HSV-2 to the seronegative partner by about 75 percent Corey and others Specifically, it reduced HIV acquisition by 39 percent 54 percent among those with high adherence and HSV-2 acquisition by 51 percent.
Similarly, the FACTS trial in more than 2, women in nine sites in South Africa found that pericoital vaginal application of tenofovir 1 percent gel was not effective in preventing HIV acquisition Rees and others An RCT involving sexually active women in southern Africa at risk for STIs found that providing condoms alone control was as effective as providing a diaphragm and lubricant gel in addition to condoms intervention in preventing chlamydia and gonorrhea Ramjee and others However, consistent use of a diaphragm could be protective given that the incidence of gonorrhea among women in the intervention arm was significantly lower among those who reported always using a diaphragm.
Pettifor and others review the literature on the effectiveness of syndromic management of STIs. Their review includes 5 studies of WHO algorithms for management of urethral discharge, 5 for genital ulcers, and 13 for vaginal discharge. Overall, the literature suggests that algorithms for urethral discharge, vaginal discharge, and genital ulcer disease can be effective. For example, La Ruche, Lorougnon, and Digbeu reported therapeutic success rates of 92 percent for male urethritis, 87 percent for vaginal discharge, and percent for genital ulcer disease.
The studies reviewed in Pettifor and others also show that the algorithms to detect cervical infection can be improved by incorporating risk scores based on factors such as sexual history. Other studies also provide evidence that risk scores can improve the efficiency of syndromic management algorithms Cornier and others Pettifor and others conclude that, although syndromic management can be effective for managing STIs, affordable, rapid, and effective diagnostic techniques to improve detection are urgently needed in resource-poor settings.
Although evidence is limited, widespread implementation of syndromic management as an approach to STI case management likely has reduced the burden of STIs, particularly in resource-poor settings Aral and others A community randomized trial in Mwanza, Tanzania, found that syndromic treatment of STIs resulted in a 40 percent reduction in HIV incidence and a reduction in symptomatic urethritis in men and prevalence of syphilis seroreactivity Grosskurth and others ; Mayaud and others Prevalence rates of other STIs were lower in the intervention communities as well, although the differences were not statistically significant for all indicators.
In a cluster randomized trial in Eastern Zimbabwe, an intervention that included syndromic management of STI had no impact over time on the incidence of STI symptoms, although male patients in the intervention communities were significantly more likely than those in the control communities to report cessation of symptoms Gregson and others A randomized trial involving men in Malawi with urethritis found that the addition of metronidazole to the syndromic management of male urethritis can reduce trichomoniasis infection in men Price and others Alam and others conducted a systematic literature review of the feasibility and acceptability of partner notification for STIs in low-resource settings and summarized the evidence that partner notification interventions can yield positive outcomes.
An RCT in Harare, Zimbabwe, involving men and women with a syndromically diagnosed STI found that a partner referral intervention client-centered, private session with a trained counselor significantly increased the likelihood that at least one partner would be reported, compared with standard care in which the treating clinician discussed partner referral Moyo and others A randomized trial in Kampala, Uganda, involving men and women with a syndromically diagnosed STI found that a significantly higher percentage of partners were treated using patient-delivered partner medication compared with patient-based partner referral Nuwaha and others Studies from the United States, for example, have shown that the administration of suppressive therapy to partners infected with HSV-2 in serodiscordant couples can reduce the incidence of HSV-2 seroconversion in uninfected partners Corey and others and that expedited partner treatment including patient-delivered therapy to a partner can reduce the risk of persistence or reoccurrence of gonococcal or chlamydial infection in the index patient Golden and others Golden and others conducted a community-level stepped-wedge RCT of a public health intervention to increase the uptake of expedited partner therapy.
The intervention increased the percentage of persons receiving patient-delivered partner therapy and those receiving partner services. The investigators estimated that the intervention was associated with reductions of about 10 percent in chlamydia positivity and gonorrhea incidence, although these reductions were not statistically significant, perhaps as a result of inadequate statistical power and of state-financed uptake of parts of the intervention in control communities.
Further trials are needed to assess the impact on STIs and cost-effectiveness of partner notification interventions in LMICs Alam and others ; Ferreira and others For example, Henley and others found that only 3. Similarly, an RCT in Malawi found that 51 percent of partners returned for counseling and testing in the provider referral group in which health care providers notified partners, compared with 24 percent in the passive referral group in which patients were responsible for notifying their partners Brown and others Furthermore, this integration could improve the diagnostics part of the HIV treatment continuum.
Interventions commonly target groups at high risk of STI acquisition and transmission. These interventions can include the provision of PPT, which is the systematic treatment of people at high risk with a combination of drugs targeting the prevalent curable STIs. As shown by four rigorous evaluations, PPT interventions can be highly effective in reducing the STI burden within targeted groups. In an RCT among female sex workers in Kenya, the provision of monthly prophylaxis substantially reduced the incidence of gonorrhea, chlamydia, and trichomoniasis, but not of HIV Kaul and others Substantial reductions in STIs were also observed among hotel-based sex workers in Bangladesh following the provision of monthly PPT over a nine-month period McCormick and others PPT with vaginal suppositories containing metronidazole and miconazole among HIV-negative women with one or more vaginal infections in Kenya and in Birmingham, Alabama, significantly reduced the prevalence of bacterial vaginosis among women during 12 months of follow-up, compared with women receiving a placebo McClelland and others Steen, Chersich, and de Vlas noted that reductions in gonorrhea and chlamydia on the order of 50 percent were common across the 15 studies included in their review of PPT of curable STIs among sex workers.
The WHO reviewed the effectiveness of presumptive treatment, finding that PPT can lead to rapid, short-term reductions in STI prevalence among high-risk groups and that ongoing STI services help sustain these reductions. However, research is needed regarding the use of PPT in high-risk populations and the impact of PPT on the emergence of antimicrobial resistance in sexually transmitted and other pathogens.
Reducing STI prevalence among core groups for example, sex workers through PPT can have notable public health effects such as prevention of STIs in the clients of sex workers , although the evidence is limited. An intervention of PPT plus STI prevention education targeted to high-risk women in a South African mining community was found to reduce the prevalence of gonorrhea and chlamydia not only in the women in the intervention but also in the miner population Steen and others In contrast, a cluster randomized trial of PPT conducted among female sex workers in Benin and Ghana found substantial reductions in gonorrhea but not in chlamydia among sex workers themselves after nine months, and no impact on the prevalence of gonorrhea or chlamydia among their clients Labbe and others For example, Avahan, the India AIDS Initiative, offers combination interventions for high-risk groups that include activities such as peer-based education, clinical services for STIs, condom promotion and distribution, and community mobilization.
Among female sex workers in Maharashtra, India, Avahan led to significant declines in the prevalence of syphilis, chlamydia, and gonorrhea Mainkar and others It also led to reductions in syphilis among high-risk MSM and male-to-female transgender persons Subramanian and others Peer-mediated interventions have also shown promise among female sex workers in Mombasa, Kenya, where peer-based STI and HIV education and condom promotion among female sex workers increased consistent condom use with clients, but these interventions did not have a statistically significant impact on STI acquisition Luchters and others The prevalence of syphilis seropositivity and trichomoniasis infection in women was significantly lower in intervention communities than in control communities, but there was no significant reduction in the prevalence of other STIs.
However, in a subanalysis of pregnant women, the prevalence of trichomoniasis, bacterial vaginosis, gonorrhea, and chlamydia was significantly lower in communities that received mass treatment. Although rigorous evaluations of the population-level impact of mass treatment strategies in LMICs are rare, mathematical modeling exercises suggest that mass treatment combined with sustained syndromic management could be an effective STI control strategy and substantially reduce STI-attributable HIV incidence Korenromp and others This model suggests that the impact of a single round of mass treatment on STI incidence would be temporary without continued rounds of mass treatment or a sustained complementary intervention, such as syndromic management.
In general, however, mass treatment is discouraged because of its cost, adverse effects, promotion of resistance, and other factors Mayaud and Mabey For example, a targeted mass treatment program to provide azithromycin to more than 4, at-risk persons in British Columbia resulted in a temporary decrease in syphilis rates, but rates rebounded rapidly and soon exceeded previous levels Pourbohloul, Rekart, and Brunham ; Rekart and others The intervention might have contributed to the rebound by increasing the number of people susceptible to infection Pourbohloul, Rekart, and Brunham Emergence of azithromycin-resistant Treponema pallidum occurred during the intervention Mabey The impact on azithromycin resistance of other bacteria was not studied.
For these and other reasons, researchers have cautioned that mass treatment interventions should not be undertaken routinely Pourbohloul, Rekart, and Brunham ; Rekart and others STI prevention interventions can be implemented at the individual, risk group, or community level.
Although this literature review is stratified by intervention modality and not by level of implementation, most of the interventions reviewed thus far were targeted to individuals or high-risk groups. Although the intervention increased knowledge and decreased reported risk behaviors, it had no apparent effect on HIV or HSV-2 seroincidence, incidence of other STIs, or pregnancy outcomes at the end of the trial Hayes and others , and no effect on HIV after about 10 years Doyle and others Community-based interventions have also been used to improve the quality of syndromic management of STIs.
A subsequent trial that chose 20 cities throughout Peru to receive or not receive this intervention resulted in substantial and significant improvements in STI syndromic management at pharmacies in the intervention cities but not in the control cities. Adjusted for baseline prevalence, among 12, young adults ages 18—29 years there was a nonsignificant reduction in chlamydia, trichomoniasis, and gonorrhea infection and in syphilis seroreactivity.
However, significant reductions were noted in certain subgroups, specifically young adult women and female sex workers in intervention cities.
Randomized trials at the clinic level offer comparable findings in Pakistan Shah and others and South Africa Harrison and others A cluster randomized trial in rural Vietnam showed that educational programs with interactive training can increase STI-related knowledge and practices of health care providers such as pharmacists, doctors, and nurses Lan and others Structural or environmental interventions to prevent STIs, including HIV, seek to change the physical and social environments in which risky sexual behavior takes place, with a focus on making healthy options the default choice Frieden ; Kerrigan and others Government policies and regulations are a common example of structural interventions.
A government policy in Puerto Plata, the Dominican Republic, requiring condom use between sex workers and clients with penalties for violations incurred by owners of sex establishments , combined with a community-solidarity intervention, was associated with a 50 percent reduction in STI prevalence among female sex workers Kerrigan and others This reduction was more substantial than that observed in Santo Domingo, the Dominican Republic, which received the community-solidarity intervention alone.
The response included three main components: the provision of condoms to commercial sex venues, the imposition of sanctions on commercial sex venues not adhering to the percent condom use policy, and a mass advertising campaign advising men to use condoms with commercial sex workers Hanenberg and others Within four years, condom use in commercial sex acts increased to 94 percent from 14 percent; STIs in males declined about 80 percent, with notable reductions in HIV incidence as well Hanenberg and others ; Punpanich, Ungchusak, and Detels Charania and others concluded that structural interventions to increase the availability of condoms do increase condom use, based on their review of 21 published studies.
These findings are not necessarily contradictory, given key differences in their approaches. For example, unlike the review by Moreno and others , the review by Charania and others focused exclusively on structural interventions, was not limited to RCTs, and examined behavioral outcomes condom use rather than health outcomes STI or HIV incidence.
A cash transfer program was tested in a trial of never-married women ages 13—22 years in Zomba District of Malawi Baird and others The provision of cash was intended to increase household income and sustain school enrollment in an attempt to offset two possible risk factors for HIV and STIs: poverty and lack of education.
The cash transfer program was shown to reduce HIV and HSV-2 incidence, indicating high effectiveness in a low-income setting Baird and others In HICs, alcohol control policies have been associated with substantial declines in alcohol-related health outcomes, such as motor vehicle fatalities and homicides Cook and Durrance They have also been shown to reduce risky sexual behaviors and STI incidence and to improve sexual health Chesson, Harrison, and Kassler ; Cohen and others ; Dee ; Grossman, Kaestner, and Markowitz ; Sen and Luong ; Staras and others Grossman, Kaestner, and Markowitz found that a 10 percent increase in the state excise taxes on beer was associated with lower gonorrhea rates among males ages 15—24 years in the United States.
Dee estimated that establishing a minimum legal drinking age of 21 years in the United States reduced childbearing by about 6 percent among black teenagers. In general, the estimated cost-effectiveness of STI prevention interventions is much higher if the potential benefits of preventing STI-attributable HIV transmission or acquisition are included. However, given the scientific debate regarding the effects on HIV of STI treatment and prevention, some experts have advised assessing the cost-effectiveness of STI prevention interventions without considering the potential impacts on HIV Galarraga and others This section focuses on studies that assess the cost-effectiveness of STI prevention in its own right, without regard to the potential effects on HIV.
The search was conducted through July using the same databases as those listed for the literature search on effective STI prevention interventions. Search terms used to identify the relevant literature are provided in annexes 10A and 10B. This search was supplemented with additional sources, such as the bibliographies of articles obtained in the search.
Costs and cost-effectiveness ratios have been updated to U. Although several studies have examined the cost-effectiveness of behavioral interventions to prevent HIV in LMICs McCoy, Kangwende, and Padian ; Townsend, Mathews, and Zembe , the literature search yielded only one study of the cost-effectiveness of behavioral interventions to prevent other STIs.
The study assessed the cost-effectiveness of an online education program for adolescents attending public schools in Colombia Chong and others The intervention addressed topics such as sexual rights, contraception, condom use and STIs and HIV, empowerment, and violence prevention.
Adult male circumcision is a cost-effective and potentially cost-saving intervention for preventing heterosexual acquisition of HIV in men, according to a review of published studies Uthman and others The cost-effectiveness of male circumcision to prevent STIs other than HIV has not been analyzed and is not of vital importance given that preventing HIV is the main goal of adult male circumcision. Goldie and others assessed the cost-effectiveness of HPV vaccination in 72 countries eligible for support from Gavi, the Vaccine Alliance.
Two key themes emerge from this literature. First, HPV vaccination of females either alone or in combination with cervical cancer screening can be highly cost-effective even in the poorest countries. Second, despite favorable cost-effectiveness, HPV vaccine programs will likely not be affordable in many countries.
A modeling study suggested that a hypothetical microbicide with 55 percent efficacy in preventing male-to-female HIV transmission would be highly cost-effective in LMICs with generalized epidemics, but it likely would be less cost-effective in HICs Verguet and Walsh Results indicate that the gel could be cost-effective or cost saving in LMICs, depending on its price.
Sahin-Hodoglugil and others used a decision tree model to examine the cost-effectiveness of three protocols for diagnosing and treating gonorrhea and chlamydia in women in Sub-Saharan Africa: gold-standard care use of the best available yet expensive diagnostic tests , syndromic management, and mass treatment. They found that the cost-effectiveness of each strategy varied by locale, depending on STI prevalence, program coverage, and health-seeking behavior. Syndromic management had two key advantages—low program costs and relative ease of implementation—which likely explains why it is often used in resource-poor settings.
This finding is consistent with a systematic review of the costs of treating curable STIs in LMICs Terris-Prestholt and others , which found that syndromic management had lower costs than other management strategies. However, syndromic management had a lower estimated impact on the percentage of chlamydia and gonorrhea cases cured than the gold-standard or mass treatment options Sahin-Hodoglugil and others Three studies examined the cost-effectiveness of strategies to improve the quality of syndromic management:.
Incorporating HSV-2 treatment could be an affordable and cost-effective strategy in certain situations, depending on factors such as the cost of HSV-2 therapy. Perhaps more important, the implementation of syndromic management for genital ulcers that includes treatment for chancroid, in accordance with the WHO guidelines WHO , has been credited with major reductions in or even elimination of chancroid in many parts of the world Ryan, Kamb, and Holmes ; Spinola ; Steen However, partner management strategies for HIV illustrate the potential for such strategies to be cost-effective for STIs.
Furthermore, partner notification is regarded as an efficient approach to identifying HIV-positive individuals in need of therapy and also identifies HIV-negative partners who may benefit from PrEP.
Borghi and others examined the cost-effectiveness of a voucher scheme implemented in Managua, Nicaragua, to increase STI services for high-risk groups, including sex workers and their clients.
The vouchers covered free STI services from a range of providers. Carrara and others examined the cost-effectiveness of providing STI clinical services and outreach to female sex workers and their male clients in Cambodia through nongovernmental organizations.
Marseille and others examined the cost-effectiveness of an intervention to distribute female condoms to female sex workers and to women with at least one casual partner per year. The distribution of 6, female condoms was expected to avert 6 HIV infections, 33 gonorrhea infections, and 38 syphilis infections and to pay for itself in averted HIV and STI treatment costs. Increasing access to STI prevention services by establishing a dedicated clinic specifically for high-risk populations could be a cost-effective strategy in LMICs.
Expanding the hours of operation, widening the geographic coverage of the clinic, and targeting additional risk groups could reduce the cost per client served.
Only one cost-effectiveness analysis of mass treatment strategies in LMICs was found Sahin-Hodoglugil and others Their decision tree analysis suggested that mass treatment offered relative advantages over gold-standard care and syndromic management in number and percentage of cases cured, but relative disadvantages in overall program costs and costs associated with overtreatment.
The decision trees used in the analysis did not account for the potential for mass treatment to promote antimicrobial resistance or for the potential adverse effects on persons treated unnecessarily.
Sweat and others examined the cost-effectiveness of environmental and structural interventions to prevent HIV among female sex workers in the Dominican Republic. The environmental intervention consisted of activities such as community mobilization, peer education, and distribution of educational materials and promotional items. The structural intervention was a system of sanctions levied on sex establishment owners for failing to follow government policies requiring condom use during sex work.
Accordingly, the structural intervention consisted of holding the establishment owners—not the commercial sex workers—responsible for ensuring that condoms were used consistently in all commercial sex transactions in the establishment. Although the cost-effectiveness ratios were sensitive to various assumptions, the inclusion of the structural intervention consistently resulted in more favorable cost-effectiveness estimates Sweat and others Studies of the cost-effectiveness of structural interventions to prevent STIs in LMICs are rare, but structural interventions could yield substantial and lasting impacts at relatively low cost.
For example, in a review of HIV prevention interventions in the United States, alcohol taxation ranked as one of the most cost-effective of all available interventions Cohen, Wu, and Farley The review focused primarily on studies of the cost-effectiveness of prevention programs for specific STIs other than HIV that did not include costs averted and health benefits gained by preventing STI-attributable HIV infections.
The inclusion of potential HIV prevention benefits could substantially alter the estimated cost-effectiveness of STI control and prevention programs Chesson and Pinkerton , particularly those targeted to high-risk populations.
To the extent that prevention or control of STIs reduces the incidence of HIV, any effective STI intervention would be expected to be cost-effective, provided that the intervention itself is not excessively costly and that its effect on HIV is not too small.
For example, Vickerman and others found that suppressive therapy for HSV-2 in women with HSV-2 and HIV could be a cost-effective public health intervention based on the benefits of reducing the progression of HIV and improving the retention of women in care, a potential benefit of HSV-2 therapy suggested by Baggaley and others To the extent that a variety of interventions targeting curable STIs might also reduce the risk of potentially fatal, incurable, and chronic STIs other than HIV such as sexually transmitted HPV, HBV, and HSV, the cost-effectiveness of such interventions would be more favorable when these additional benefits are included.
However, their cost-effectiveness is generally not as sensitive to the inclusion of other STI-related benefits as the reverse.
For example, circumcision is a highly cost-effective and potentially cost-saving intervention for the prevention of HIV acquisition in men Uthman and others Because it is cost-effective when considering HIV-related benefits alone, there is little need to include the potential benefits of preventing other STIs, at least in settings where prevention of other STIs is not the primary goal of circumcision.
The prevention of mother-to-child transmission of HIV and syphilis is addressed in chapter 6 of this volume John-Stewart and others However, screening and treatment for syphilis in pregnancy warrants special mention here for several key reasons. First, the global burden of disease due to syphilis during pregnancy is comparable to that of mother-to-child transmission of HIV WHO b.
Second, screening and treatment for syphilis in pregnancy is an inexpensive and highly cost-effective intervention Blandford and others ; Hawkes and others ; Kahn and others ; Owusu-Edusei, Gift, and Ballard ; Rydzak and Goldie ; Schmid ; Terris-Prestholt and others However, despite their low cost and favorable cost-effectiveness, screening for and treatment of syphilis in pregnancy are vastly underutilized in LMICs today WHO b.
Similar data exist for HBV vaccination Kane Aral and others examined the association between two economic measures—income and income inequality and STI burden—at the country level. For each country setting, income was measured using gross national income, and income inequality was measured using the Gini coefficient, which can range from 0 complete equality to 1 complete inequality.
The burden of STIs was negatively associated with income and positively associated with income inequality. Their analysis suggested that these two economic measures could explain almost half of the variation across countries in STI prevalence among low-risk groups 16 percent of the variation among high-risk groups.
These findings are consistent with other analyses in HICs. Bingham and others used the Gini coefficient to examine income inequality and gonorrhea incidence rates across 11 countries.
Their analysis showed significant positive associations between income inequality and gonorrhea rates in women. Owusu-Edusei, Chesson, Leichliter, and others examined county-level data in the United States and found that racial disparities in income were associated with racial disparities in STI burden. One possible explanation is that racial income disparity contributes to residential segregation by race, which has been identified as a social determinant of STI risk Hogben and Leichliter ; Owusu-Edusei, Chesson, Leichliter, and others ; Thomas and Gaffield Aral and others provided the following list of priorities for global STI research, and they remain priorities today:.
STIs impose a considerable health and economic burden globally. Primary prevention and control of STIs in LMICs can be an efficient use of resources, although the impact and cost-effectiveness of interventions can vary substantially across settings. Furthermore, estimates of the cost-effectiveness of STI control in LMICs can be subject to considerable uncertainty and might not be generalizable across settings. The findings of this literature review should be considered in light of the limitations inherent in cost-effectiveness studies of STI control in LMICs, such as incomplete cost data and imprecise estimates of program impact.
Only latex condoms offer this protection. A female condom, made as a lubricated polyurethane sheath, and called Reality, is also available. Follow instructions on the product packaging for proper use. Studies show that if your teenager has one or more of the following characteristics, he or she has an increased chance of getting a sexually transmitted disease:.
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Page Content. Using Condoms Properly Even though you may have clearly spoken with your teenager about the advantages of waiting to have sex, you need to talk with her about birth control. Share the following guidance on correct male condom use with your teenager: A new condom should be used every time your teenager has sex.
Condoms need to be handled with care to prevent tearing or cutting them with fingernails, teeth, or sharp instruments. A condom should be placed on the penis after it is erect and before any genital contact. Sufficient lubrication should be used during intercourse with a condom. If a lubricant is used on the outside of the condom, it should only be a water-based product such as K-Y Jelly, Astroglide, or Aqua-Lube.
Oil-based lubricants such as petroleum jelly or body lotion can weaken the latex material. During withdrawal, the condom should be held tightly against the base of the penis to keep it from slipping off. Withdrawal needs to be done while the penis is still erect. Is Your Teenager at Risk? The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician.
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