Effective prevention and care of STI can be achieved using a combination of responses constituting the "public health package". The essential components of this package are shown in the box.
The public health package for STI prevention and care: the essential components
• promotion of safer sex behaviour
• condom programming - encompassing a full range of activities from condom promotion to the planning and management of supplies and distribution
• promotion of health-care-seeking behaviour
• integration of STI prevention and care into primary health care, reproductive health care facilities, private clinics and others
• specific services for populations at risk - such as female and male sex workers, adolescents, long-distance truck drivers, military personnel, and prisoners
• comprehensive case management of STI
• prevention and care of congenital syphilis and neonatal conjunctivitis
• early detection of symptomatic and asymptomatic infections.
COMPREHENSIVE CASE MANAGEMENT OF STI
One of the essential components of the public health package is comprehensive case management of STI, which comprises:
Identification of the syndrome: This can be done through syndromic diagnosis or laboratory tests.
Educating the patient: Patients should be informed about the nature of the infection, the importance of taking the full course of medication, among other things.
Antibiotic treatment for the syndrome: Whichever means is used for diagnosis - flow charts or laboratory tests - the availability and use of effective antibiotics is an absolute requirement. The drugs must be available at the first point of contact with a patient with an STI. Effective treatment must also be available and used in the private sector.
Condom supply: With people being encouraged to use condoms, health authorities should ensure that there is an adequate supply of good-quality, affordable condoms at health facilities and at various other distribution points in the community. Social marketing of condoms is another way of increasing access to condoms.
Counselling: Counselling should be made available for cases where it is needed - for example, in chronic cases of genital herpes or warts - either for individuals or for couples in a sexual relationship.
Information on partner notification and treatment: Contacting sex partners of clients with STI, persuading them to present themselves to a site offering STI services, and treating them - promptly and effectively - are essential elements of any STI control programme. These actions, however, should be carried out with sensitivity, with social and cultural factors taken into account. This will avoid ethical problems, as well as practical problems such as rejection and violence, particularly against women.