Policy

WHO/Europe is developing a regional framework for implementing the global strategy for the prevention and control of STIs 2006–2015 in the WHO European Region.

The essential components of a public health package for STI prevention and care are:

• promotion of safer sexual behaviour and health-care-seeking behaviour;
• programmes to promote the use of condoms;
• integration of STI control into primary and reproductive health care facilities, private clinics and other settings;
• specific services for populations with high-risk behaviour;
• comprehensive case management of STIs;
• prevention and care of congenital syphilis and neonatal conjunctivitis;
• early detection of symptomatic and asymptomatic infections; and
• monitoring of drug sensitivity. 

Effective management: cornerstone of control and prevention

Appropriate management, starting at the first contact between patients and health care providers, is an important public health measure. Failure to diagnose and treat STIs at an early stage can result in infertility, fetal wastage, ectopic pregnancy, anogenital cancer and premature death, as well as neonatal and infant infections.
 
Effective management:

• prevents the development of complications and sequelae;
• decreases the spread of STIs in the community; and
• offers a unique opportunity for targeted education on HIV prevention.

Other important considerations

• Individual and national expenditure on STI care can be substantial.

• Th emergence and spread of HIV infection and AIDS have complicated the management and control of some STIs.

• Antimicrobial resistance of several sexually transmitted pathogens is increasing, rendering some regimens ineffective. New agents, capable of treating infections with resistant strains, are available but remain expensive.

Approach when resources are limited

Etiological diagnosis of STIs is difficult in many resource-constrained settings. This increases costs and reduces access to treatment. In some countries, health care facilities lack the equipment and trained personnel required for etiological diagnosis. The syndrome-based approach to the management of STI patients, developed and promoted in many countries, helps to overcome this problem.

This approach is based on identifying consistent groups of symptoms and easily recognized signs (syndromes), and providing treatment that deals with most of or the most serious organisms responsible for producing a syndrome. WHO has developed a simplified flowchart/algorithm to guide health workers in implementation.

WHO global strategy

The global strategy for the prevention and control of STIs 2006–2015 offers promising prospects of significantly reducing STIs and HIV in countries by:

• scaling up of diagnosis and effective treatment using syndromic management and/or laboratory testing to more than 90% of primary point-of-care sites;
• expansion of point-of-care testing and treatment of syphilis in pregnancy to over 90% of women attending antenatal care services;
• implementation of enhanced national programmes of second-generation HIV surveillance, which includes STI biomedical and behavioural surveillance;
• targeted interventions that address populations at higher risk of STIs (including services to people living with HIV); and
• age-appropriate comprehensive sexual health education and services to improve young people’s knowledge and skills in preventing infection.

To achieve significant impact, the global strategy calls for the implementation of the following enabling interventions at the global, regional and national levels.

• Increase the commitment of national governments and policy-makers, and national and international partners to STI prevention and control.
• Advocate the mobilization and reallocation of resources to focus on priority programme areas where they are likely to have the greatest impact.
• Promote policies, laws and initiatives on STI control that support non-stigmatizing, culture- and gender-sensitive programmes and services.
• Harness the strengths and capacities of all partners and institutions to scale up and sustain interventions for STI prevention and control.