STI testing in Europe, accessibility and availability

I. Sziller1st Dept. Obstetrics and Gynecology, Semmelweis

University Medical School

„Renaissance” of STI

• STI’s are of public health priority in their own right

• frequency

• potential morbidity

Significance of STI

• Late sequelae– infertility men/women

– ectopic pregnancy

– cervical cancer

– premature mortality

– congenital syphilis

– fetal wastage

– low birth weight/prematurity

– ophtalmia neonatorum

Rate of ectopic pregnancy in Hungary (1931-2000)

„Renaissance” of STI

• A new pathogen (HIV) was needed to lead to urgent reappraisal of their control strategies

WHO

• UNAIDS - prevention of STI

• improves the health status, and

• prevents HIV transmission

• high priority to the development of appropriate programs

WHO, 2002

EUROPE

Incidence of STI in reproductive ages, 1995

Region new cases/year(x1000)

incidence/100015-49 year old

N. America 14.000 91

W. Europe 16.000 77

E. Europe 18.000 112

S/SE Asia 150.000 160

Total 333.000 113

Differences between E & W

• Failure to recognize the problem

• diagnosis of symptomatic patients

• STD clinics only• inadequate coverage

• stigmatization

• low cost antibiotics

• missing education/prevention

• Recognition of the problem

• identification of asymptomatic patients

• interdisciplinary diagnosis• wider coverage

• no stigmatization

• antibiotics

• education/primary & secondary prevention

Care for STI’s

• Two sides of the coin

• availability– diagnostic procedures: quality and quantity

– treatment: effectiveness, cost

• accessibility– the population to be tested/screened

» appropriate population?

– public health service

Syphilis

• Classic example of STI

• control by public health measures

• highly sensitive diagnostic test

• highly effective and affordable treatment

Syphilis

W. Europe

• peak after II. World War

• decline of incidence to 5/100.000

E. Europe

• peak after II. World War

• decline until 1990

• since that time alarming increase to 120-170/100.000 in 1996 in the former soviet countries

Gonorrhoea

• Basic facts– common STI

– 80% of infected women, 10% infected men asymptomatic

• Diagnosis– needs sophisticated equipment

– costly, not available in some countries

• Treatment– effective, affordable

Gonorrhoea

W. Europe

• decline 1980-1991 to below 20/100.000

• from 1990, 30-35% increase in England/Wales, Sweden, etc.

E. Europe

• decline until early 1990’s

• substantial increase to 111-139/100.000 in Baltic countries

Control of gonorrhoea

• Accessibility

– public health advantage in communities where testing/screening policy covers a broad spectrum of pts

» university clinics, family planning clinics

– higher or increasing rates in communities where STD or VD clinics only

Chlamydia

• Basic facts• common cause of cervicitis/urethritis, and PID• subsequent risk for infertility

• Diagnosis• sensitive but costly methods• significant differences among W. European countries

and between E-W Europe

• Treatment• effective and costly

Chlamydia

• Great differences between E & W

• recognition of the medical problem by health care authorities

• recognition of its public health importance

Prevalence among asymptomatic women

Iceland 8.0

Denmark 6.7

UK 6.2

Hungary 5.4

The Nederlands 4.9

France 3.9

Italy 2.7

Chlamydia

W. Europe– wide coverage for

Chlamydia testing

– screening programs in the early 1970’s in some countries

– falling rates of new cases and late consequences

E. Europe– narrow coverage for

Chlamydia testing

– no screening programs

– increasing incidences and late consequences

Trichomoniasis

• Basic facts• the most common STI, limited data

• increased HIV virus seroconversion

• adverse pregnancy outcome

• Diagnosis• effective, available, accessible

• Treatment• effective, low cost

• resistant cases

Trichomoniasis

W. Europe

• 10 million new cases annually

• slight decline

E. Europe

• 13 million new cases annually

• slight increase

Conclusions

• Significant differences between E & W Europe with regard to STI’s

• marker of differences between health care status of the two sub-regions

» cardivascular diseases

» malignant diseases

» life expectancy, etc.

Conclusions

• Future prospects• national programs in all countries

• inclusion of not only classic STI’s and HIV/AIDS

• screening programs

• education

• promotion of use of barrier methods

• availability

• accessibility