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The other STDs. Linked with HIV transmission, they are attracting new attention.


 Health officials began neglecting sexually transmitted diseases (STDs) (syphilis, gonorrhea, chlamydia, trichomoniasis, and chancroid) when the AIDS epidemic began. They now refocus efforts on STDs because data indicate that STDs facilitate HIV transmission. Even though the risk of HIV transmission is lower in people with nonulcerative STDs than those with genital ulcers (0-4 vs. 2-5 times), the link between nonulcerative STDs and HIV transmission is a greater problem since nonulcerative STD cases occur more often than genital ulcers. Many AIDS control programs execute STD control activities. Countries must improve existing STD control programs. They should strengthen STD surveillance. Viet Nam has established surveillance sites at STD clinics in 4 cities. Training different health providers in STD control would make STD services accessible to more people. These providers include nurses, midwives, pharmacists, and even traditional healers and should be based at pharmacies and primary health care, maternal and child health, and family planning clinics. Primary health care workers should use symptoms to diagnose and treat STDs rather than laboratory tests. 1 drawback of this syndromic approach is that about 50% of women do not exhibit STD symptoms. STD control programs must guarantee a steady reserve of drugs. In Zimbabwe, primary health clinics receive STD drugs from a decentralized drug distribution system (5-8 warehouses) rather than the older centralized system (1 warehouse). This has reduced the waiting time from 6 months to 4-6 weeks. Programs need to encourage individuals to seek early treatment of STDs via health education campaigns (e.g., mass media), outreach to high risk groups such as prostitutes and the patron, and contact tracing. STD counselors should promote condom use. An STD program in Nairobi, Kenya informs patients to use a condom during sex with any causal sex partner, shows patients how to put on and take off the condom, and tells them where they can obtain condoms.
