Since the concept of sexually transmitted diseases (STDs) was
first described, the spectrum of diseases included in this category has expanded greatly.
Currently, more than twenty microorganisms are known to be transmissible through sexual
intercourse. The complications arising from STDs, from pelvic inflammatory disease in
particular, present enormous public health problems. In addition, transmission of
hepatitis B and AIDS is facilitated by ulcerative genital conditions, and possibly by
vaginitis and cervicitis.
To address these public health problems and help the greatest number of clients,
practical and economical STD diagnosis and treatment programs are required. Because
sexually transmitted disease (STD) and family planning services overlap substantially, it
is important to provide STD screening for family planning clients. STDs frequently are
encountered in family planning clients, especially in certain high-risk groups (e.g.,
clients who have more than one sexual partner).
The main linkages between STD services and family planning are:
- prevention, and
- client screening.
Prevention
It is important to educate all clients about:
- high-risk sexual behaviors, and
- the protective benefits of condom use (and the limited effectiveness of diaphragms and
spermicides).
In addition, if a client is found to have a STD, recommend that her/his sex partner(s)
be evaluated and treated as well.
Client Screening
Because a thorough examination (including microbiologic and serologic studies) of all
family planning clients usually is not possible, at a minimum, the risk of STDs in all
clients should be assessed. Effective screening does not require the use of complicated
protocols or costly laboratory tests. To do this, health care providers should:
- be knowledgeable about high-risk sexual practices,
- be aware of the signs and symptoms of STDs,
- be aware of which STDs are particularly common in their client population, and
- carefully evaluate clients in whom STDs are suspected based on their medical history or
physical examination findings.
Questions a STD screening history should include:
- Do you have a vaginal discharge?
- In the past year, have you had a genital tract problem such as a vaginal discharge,
ulcers or skin lesions in your genital area?
- Has your sex partner been treated for a genital tract problem, such as discharge (drip)
from the penis or swollen groin glands, in the last 3 months? Which?
- Do you know if your sex partner has other sex partners?
- Are you or your partner in a profession that puts you at high risk (e.g., commercial sex
worker, driver, military)?
- Have you had more than one sex partner in the last 2 months?
- Do you think that you might have a
STD?
What are GTIs?
- GTIs are genital tract infections caused by a small number of microorganisms (bacteria,
viruses and fungi) which usually are sexually transmitted.
- Most STDs are GTIs, although some STDs such as hepatitis B and AIDS (which are primarily
but not exclusively sexually transmitted) are also systemic diseases.
- Most GTIs (e.g., gonorrhea, syphilis) can be treated. All can be prevented; and if not
prevented, early diagnosis and treatment can decrease the possibility of serious
complications such as infertility in both women and men.
GTIs are a Significant Problem
GTIs are almost as common as malaria: > 250 million new cases each year.
The consequences of untreated GTIs are devastating; they include:
- Ectopic pregnancy (7–10 times increased risk in women with history of PID)
- Increased risk of cervical cancer
- Chronic abdominal pain (18% of females with a history of PID)
- Infertility:
- 20–40% of males with untreated chlamydia and gonorrhea
- 55–85% of females with untreated PID (8–20% of females with untreated
gonorrhea develop PID)
- Increased risk of HBV and HIV/AIDS transmission
In addition, infants can be infected at birth with blinding eye infections and
pneumonia, suffer central nervous system damage or die as a result of GTIs and STDs.
In view of the enormous health problems caused by sexually transmitted GTIs, coupled
with the limited resources available in many countries, reducing the incidence of GTIs is
unrealistic. A more realistic aim is to reduce the number of GTI complications, such as
PID and both male and female infertility, and to reduce the transmission of HBV and
HIV/AIDS.
Diagnosis and Treatment
In primary health care facilities, diagnosis of GTIs usually rests solely on clinical
findings (signs/symptoms) or risk assessment. For secondary health care facilities,
however, where pelvic examinations can be done and a microscope and simple laboratory
testing are available, greater accuracy in managing the most frequently encountered GTIs
often is possible.
 
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