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Why Should Reproductive Health Services Focus on STIs/RTIs?
The human costs of HIV and other STIs are incalculable. Premature deaths and disabilities not only devastate families, but also threaten the cultural and economic stability of communities, countries, and whole continents. Seriousness of complicationsEven curable STIs can cause serious complications if left untreated. If they are not diagnosed and treated in time, some of these infections can cause infertility, chronic pelvic pain, premature labor and delivery, spontaneous abortion, ectopic pregnancy, inflammation of the testes, cardiovascular or neurological complications, or even death. Some infections can also lead to pneumonia, respiratory infections, and eye infections in infants. Links to HIV and AIDSSTI treatment and prevention can be an important tool in limiting the spread of HIV infection since:
For example, a person who has chancroid, chlamydia, gonorrhea, syphilis, or trichomonas infection can have as much as nine times the risk of getting HIV from a sexual partner as a person who is not infected with one of these STIs. An ulcerative STI (such as genital herpes, syphilis, or chancroid) increases the risk of HIV transmission per exposure significantly more than a nonulcerative STI (such as gonorrhea or chlamydia) since HIV can pass more easily through genital ulcers. But STIs that do not cause ulcers also increase risk because they increase the number of white blood cells (which have receptor sites for HIV) in the genital tract, and because genital inflammation may result in damage that can allow HIV to enter the body more easily. In addition, HIV infection may complicate diagnosis and treatment of other STIs because HIV may change the patterns of disease or clinical manifestations of certain infections and may affect laboratory tests. In people with HIV infection, STI symptoms may be more severe, the period of infectivity may be increased, and normal treatments may fail. Family planning methods and STIs/RTIsContraceptive methods other than male or female condoms are not effective against the transmission of STIs, including HIV. While spermicides and barrier methods, such as the diaphragm, may offer some increased protection against bacterial STIs (e.g., gonorrhea, chlamydia), the increased protection such methods offer is fairly low. Recent research results indicate that women who use some hormonal contraceptives (oral contraceptives or Depo-Provera) have an increased risk for contracting some STIs/RTIs but a decreased risk for contracting others. For example, women using oral contraceptives were at increased risk for chlamydia and vaginal yeast infections, but decreased risk for bacterial vaginosis (BV) compared to women not using family planning. This altered susceptibility to STIs could influence transmission of HIV. There has also been some concern about the possibility of hormonal contraceptives increasing HIV susceptibility due to endometrial, cervical mucus, or bleeding changes that can occur with use of these methods. Some evidence suggests that methods with higher levels of progestins may increase risk; however, other studies have found mixed results. Additional research on this topic is needed. Women who use hormonal methods are less likely to use condoms, so it is important to target these women with counseling messages promoting dual protection (i.e., hormonal methods for pregnancy prevention and condom use for disease prevention). Intrauterine devices (IUDs) have been considered an inappropriate method for women at risk for STIs because of concerns about the potential increased risk for pelvic inflammatory disease (PID) following IUD insertion in women with cervical infections (gonorrhea, chlamydia, or both). The risks associated with IUD use may have been overstated in the past. Based on current evidence, it appears that PID rates associated with IUD insertion in women with cervical infections fall within or below the range of rates reported in infected women who do not have an IUD inserted. There is an inherent risk for PID in infected women even without an IUD insertion. The level of risk for PID is dependent on the prevalence of gonorrhea and chlamydia in the population seeking family planning. In many settings, the prevalence is low. Symptomatic PID caused by IUD use is actually quite uncommon, even where STI prevalence is quite high. The vast majority of women with cervical infection who receive an IUD do not develop PID. Asking screening questions related to STI risk could greatly reduce risk by screening out a high percentage of those likely to be infected. IUD use may be unnecessarily restricted in many settings. No missed opportunitiesBecause STIs and other RTIs are a widespread global problem, it is important for health care providers to take advantage of all opportunities to communicate prevention messages. Providers are in a unique position to contribute to these efforts. In addition to discussing STI/RTI prevention with clients, providers can address clients’ concerns and answer clients’ questions. For many women, family planning and antenatal care visits are their only contact with the health care system and are the only opportunity for them to receive information about the prevention of and the potential impact of HIV and other STIs/RTIs on their sexual and reproductive health.
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STIs and other RTIs are a rapidly
growing problem throughout the world. Although the impact of STIs is serious
in both developed and developing countries, it is most profound in the
developing world:
