STI/RTI basics
Chapter 1. Infections of the male and female reproductive tract and their consequences

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What can be done about RTIs?

Most of the serious health problems caused by STIs/RTIs are preventable. Communities with good access to effective prevention and treatment services have lower rates of STI/RTI and STI/RTI complications than communities where services are poor, disrupted or not used by people at risk. Reducing the burden of STI/RTI requires more than good clinical management of individual patients, however. STIs/RTIs are transmitted in the community, and limiting interventions to clinic settings misses much of the problem. Box 1.4 lists some important barriers to controlling STIs/RTIs at the community level, and what can be done about them.

 

Box 1.4. Some barriers to STI/RTI control at the community level

What is the problem?	What can be done?
Poverty and labour migration separate families and lead to risky sexual behaviour.	Economic and social policies that reduce family separation may reduce risk and vulnerability.
Low status of women limits economic options and leads to risky sexual behaviour. Women may exchange sex for money or other forms of support. Low status also means little control over decisions and less ability to negotiate with partners.	Educational and employment opportunities for girls reduce the economic pull of sex work, empower women and reduce STI risk.
Poor health care services have little to offer for prevention and care of STI/RTI.	Improved health care services mean better prevention and care.
People do not have easy access to health care facilities.	Reducing barriers such as cost, distance, limited clinic hours and long waiting times means better access to care.
People do not use health care facilities (poor health-care-seeking behaviour).	Better awareness of STI/RTI symptoms and complications, and promotion of improved health care services will convince more people to use services.

 

Some countries have greatly reduced the prevalence and transmission of common STIs/RTIs by addressing such social and structural factors. Thailand recently reduced the incidence of the most common STIs by over 90% by promoting increased condom use and improving STI treatment among commercial sex workers (Box 1.5). Maternal morbidity due to complications of childbirth and abortion has declined dramatically in countries where safe services are available. High rates of preventable reproductive morbidity and mortality in other countries make prevention and control of these infections a public health priority.

 

Box 1.5. Effective STI control and HIV prevention in Thailand

In response to a rapidly growing HIV epidemic in the late 1980s, Thailand took steps to reduce sexual transmission of HIV and other STIs. Condom use was strongly promoted, particularly in commercial sex networks, and STI diagnosis and treatment were strengthened. Within five years, condom use reported by sex workers had risen from 14% to 94% and STI rates were declining (see Figure 1.2). During this period, HIV prevalence declined in both high-risk groups and pregnant women (not shown). Strong government commitment and the use of targeted strategies to reach the populations where most STI transmission was taking place were important elements of Thailand�s success.

 

Figure 1.2. Clients using condoms and reported STI cases�Thailand