The knowledge of the epidemiology of STD in the developing world had increased considerably during the last decade. This better understanding combined with the emergence of the epidemic of a new fatal STD (HIV) encouraged health planners to define appropriate effective and feasible STD control strategies. Major progress has been made with regard to the primary prevention and optimal case management of STD, both in terms of strategies and feasibility of implementation in field conditions.
PIP: Even though the population of developing countries is heterogeneous, it is young, and the incidence and prevalence of sexually transmitted diseases (STDs) are likely to increase among persons aged 20-40. STD epidemiologic data tend to be unreliable in most developing countries. Zimbabwe, a country with a good information system, has about 1 million reported STD cases each year (40% urethritis, about 25% genital ulcers, and 20% vaginal discharge and/or pelvic inflammatory disease). Gonococcal infections among pregnant women vary from 2% to 20% in Africa and are 10-20 times higher here than in comparable populations in the West. Chlamydial infection rates in developing countries tend to be similar to and lower than rates in the West. Syphilis prevalence rates range from 1% to 20% in some developing countries. STD complications and their sequelae pose an important public health problem for developing countries. They mostly affect women and newborns. STD complications and their sequelae include spontaneous abortion, fetal death, low birth weight, congenital syphilis, blindness, infertility, and social and personal damage. It appears that STDs facilitate HIV transmission. HIV-related immune deficiency increases one's susceptibility to genital ulcers. Increasing resistance to antibiotics complicates treatment of gonorrhea and chancroid. HIV infected persons respond poorly to classic treatment of chancroid. Two major STD interventions are prevention through behavior modification and promotion of barriers and limiting the duration of infection through optimal case management and case finding activities. The emergence of HIV has placed primary prevention as an absolute priority. Social marketing of condoms has been successful in several developing countries. Provision of accessible and affordable care can change health seeking behavior of persons with STDs such that they seek care from medical services. The primary health care systems of several developing countries use simple diagnostic algorithms to identify STD cases.