Controlling STI (Sexually Transmitted Infections)

The approach to controlling STIs and the emphasis placed on different components will depend on the local pattern and distribution of STIs in the community and whether one is working in a setting that is resource rich or resource poor.
However, the same general principles will apply. Prevention can be aimed at uninfected people in the community to prevent them from acquiring infection (primary prevention) or at infected people to prevent the onward transmission of the infection to their sexual partners (secondary prevention).

Although effective primary prevention can theoretically reduce the prevalence of viral and bacterial STIs, secondary prevention is much more effective at reducing the prevalence of bacterial STIs, which all are curable with antibiotics. In fact, the population prevalence of a bacterial STI can be reduced entirely through effective secondary prevention activities without any reduction in risky sexual behavior occurring.

Countries that combine primary and secondary prevention approaches, at the individual and population levels, have managed substantially to reduce the burden of infection in their population. Effective implementation of prevention programmes requires strong political leadership and genuine commitment, without which the most well designed and appropriate programmes are likely to founder. Countries such as Thailand, Brazil, Uganda, and Senegal have seen a dramatic impact on their rates of STIs and HIV, which has been facilitated greatly by political support at the highest level.

Interventions that reduce the rate of STI can be aimed at the entire community or targeted at specific groups who are at high risk of, or are particularly vulnerable to, infection. One to one prevention interventions can take place in clinic settings, such as:

Primary Prevention

Primary prevention interventions aim to keep people uninfected. These approaches are obviously not mutually exclusive. Individual behaviour change probably will be best sustained in a community that is broadly supportive. In addition, the broader cultural mores of the community will influence greatly the feasibility of delivering education in that community and will also affect how people respond to it.
• Behavioural interventions are aimed at enhancing knowledge, skills, and attitudes to help people protect themselves against infection (for example, health promotion to decrease partner change and increase condom use)
• Structural interventions are aimed at broader societal and economic issues that drive the spread of STIs
• Biomedical interventions include condoms, vaccines, vaginal microbicides, or male circumcision to prevent the acquisition of infection