Treatment Concerns

Cost and access

Accessing appropriate treatment is a challenge in some low-resource settings, where clinics may not have the necessary supplies, drugs, or trained health care professionals to provide adequate and appropriate sexually transmitted infection (STI) and reproductive tract infection (RTI) services.

The availability of effective drugs is an essential requirement for STI/RTI services, which should ideally offer a cure rate of at least 95%, according to the World Health Organization (WHO).

Unfortunately, many of the drugs used to treat STIs/RTIs are too expensive to be within the reach of low-resource settings, and government health departments sometimes choose cheaper, less effective treatments that may actually help perpetuate infection by not curing the infection and encouraging the emergence of antibiotic-resistant organisms. In addition, the use of ineffective or partially effective treatments may actually increase a clinic’s overall costs since clients will repeatedly return for treatment for the same infection or for more costly treatment for complications of the original infection. A client with an ineffectively treated infection will also be more likely to infect or reinfect sexual partners, who will then also need treatment.

Antibiotic resistance

Some of the microorganisms that cause STIs have developed resistance to antibiotics that were at one time the treatment of choice for that infection. For example, penicillin and tetracycline, once the drugs of choice for the treatment of gonorrhea, are no longer recommended because of widespread antibiotic resistance.

Antibiotic resistance can develop when inappropriate drugs are used, when drugs are taken at lower than optimal doses, or when less than a full course of treatment is followed. Unfortunately, many of the less expensive treatments once effective against STIs have since become ineffective due to the emergence of resistant strains.

Both providers and clients can contribute to development of antibiotic resistance. For example, providers may prescribe inappropriate drugs, use lower than optimal doses in an attempt to control costs, or not treat the infection for a long enough period of time. Likewise, clients may not take the full course of therapy they are given (they often stop taking the drugs if symptoms disappear or if they have a side effect) or they may self-treat, selecting inappropriate drugs, doses, or treatment regimens. Self-treatment is common in many low-resource settings where antimicrobial drugs are widely available to the general public without a prescription.

Single-dose therapy is currently available for a number of STIs, including syphilis, chlamydia, gonorrhea, chancroid, and trichomonas infection. The biggest advantage of single-dose therapy is that the provider can be assured that the client has received all of the drug necessary to cure the infection. In addition, single-dose therapy is more convenient for the client. Unfortunately, these single-dose therapies are often more expensive than other drugs and might not be affordable or readily available in many low-resource settings.

Some examples of single-dose treatment for STIs include the following:

HIV and AIDS

Currently, there is no cure for HIV infection or AIDS. However, with the combined use of new antiretroviral drugs and drugs to prevent opportunistic infections, many people with HIV infection and AIDS have extended and improved the quality of their lives and delayed the progression of HIV infection to AIDS.

These drugs can cause a number of side effects that may require a person to switch to other drugs or to stop taking them. In addition, combination therapy may require taking a large number of pills on a complicated schedule. These drugs are also very costly and unavailable to many people in industrialized countries, as well as in many parts of the developing world, where the majority of individuals with HIV infection and AIDS live.

Since the presence of other STIs can increase transmission and acquisition of HIV infection, as well as hasten the development of AIDS, efforts to diagnose and treat curable STIs have become a major strategy in combating the HIV epidemic. Although ulcerative STIs (e.g., syphilis, herpes) can most readily facilitate HIV transmission, other STIs have been shown to do so as well.

(For more detailed information about HIV infection and AIDS, you may want to review EngenderHealth’s minicourse on HIV and AIDS after completing this minicourse on STI/RTI.)

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