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When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Although highly effective, condoms do not offer protection for STIs that cause extra-genital ulcers (i.e., syphilis or genital herpes). When possible, condoms should be used in all vaginal and anal sex.

Overview

Over 30 types of bacteria, viruses and parasites are usually transmitted by sexual contact – vaginal, anal and oral sex.Some are transmitted from mother-to-child during pregnancy, childbirth and breastfeeding.And of the eight pathogens linked to the greatest incidence of STIs, only 4 are currently curable. These are Syphilis, Gonorrhoea, Chlamydia and Trichomoniasis.

The other four which are viral infections are incurable – Hepatitis B, Herpes Simplex virus (HSV), HIV and Human Papillomavirus (HPV).

In addition, Monkeypox, Shigella sonneiNeisseria meningitidis, Ebola and Zika, are other emerging new infections. Similarly, the re-emergence of neglected STIs such as lymphogranuloma venereum.

These herald increasing challenges in the provision of adequate services for STIs prevention and control.

What is the scope of the problem?

In 2020, WHO estimated 374 million new infections with 1 of 4 STIs: chlamydia (129 million), gonorrhoea (82 million), syphilis (7.1 million) and trichomoniasis (156 million).

More than 490 million people were estimated to be living with genital herpes in 2016, and an estimated 300 million women have an HPV infection, the primary cause of cervical cancer and anal cancer among men who have sex with men.

An estimated 296 million people are living with chronic hepatitis B globally.

STIs can have serious consequences beyond the immediate impact of the infection itself.

  • STIs like herpes, gonorrhoea and syphilis can increase the risk of HIV acquisition.
  • Mother-to-child transmission of STIs can result in stillbirth, neonatal death, low-birth weight and prematurity, sepsis, neonatal conjunctivitis and congenital deformities.
  • HPV infection causes cervical and other cancers.
  • Hepatitis B resulted in an estimated 820 000 deaths in 2019, mostly from cirrhosis and hepatocellular carcinoma. STIs such as gonorrhoea and chlamydia are major causes of pelvic inflammatory disease and infertility in women.

Prevention of STIs

When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Although highly effective, condoms do not offer protection for STIs that cause extra-genital ulcers (i.e., syphilis or genital herpes). When possible, condoms should be used in all vaginal and anal sex.

Safe and highly effective vaccines are available for 2 viral STIs: hepatitis B and HPV. These vaccines have represented major advances in STI prevention. By the end of 2020, the HPV vaccine had been introduced as part of routine immunization programmes in 111 countries, primarily high- and middle-income countries. To eliminate cervical cancer as a public health problem globally, high coverage targets for HPV vaccination, screening and treatment of precancerous lesions, and management of cancer must be reached by 2030 and maintained at this high level for decades.

Research to develop vaccines against genital herpes and HIV is advanced, with several vaccine candidates in early clinical development. There is mounting evidence suggesting that the vaccine to prevent meningitis (MenB) provides some cross-protection against gonorrhoea. More research into vaccines for chlamydia, gonorrhoea, syphilis and trichomoniasis are needed.

Other biomedical interventions to prevent some STIs include adult voluntary medical male circumcision, microbicides, and partner treatment. There are ongoing trials to evaluate the benefit of pre- and post-exposure prophylaxis of STIs and their potential safety weighed with antimicrobial resistance (AMR).

Be advised to practise safe sex at ll times.

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