Control of sexually transmitted infections (STIs) and STI screening
There is now substantial evidence from observational, biological and intervention studies to show that STIs (both ulcerative and non-ulcerative) may increase the susceptibility of uninfected individuals to HIV and increase the infectiousness of HIV positive individuals.
Control of STls therefore has an important role in the primary prevention of HIV. In the UK, the network of GUM clinics provides open-access services for screening, treatment and partner notification for STIs. STI control is particularly important among populations at high risk of HIV infection. Screening and treatment offer an opportunity to focus behavioural interventions on those who have STIs. Increasingly, GUM clinics are recognising the importance of offering regular STI screening as part of routine HIV treatment services alongside appropriate counselling on risk-reduction strategies.In developing countries, where the burden of untreated STIs is much greater and diagnostic and treatment services more limited, syndromic management approaches have been used. These combine clinical history with knowledge of local pathogens to devise treatment algorithms. Such strategies however appear to be most effective in terms of their specificity and sensitivity in identifying STI cases, where the prevalence of STIs is high.
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