P. Piot et Mq. Islam, SEXUALLY-TRANSMITTED DISEASES IN THE 1990S - GLOBAL EPIDEMIOLOGY AND CHALLENGES FOR CONTROL, Sexually transmitted diseases, 21(2), 1994, pp. 190000007-190000013
Epidemiologic trends of STD are strikingly different in various parts
of the world. In Northern and Western Europe there has been a spectacu
lar decline in the incidence of STD, particularly gonorrhea and syphil
is. It is probably due to a combination of an early initiation of sex
education at school, behavior change, condom promotion, and the wide a
vailability of STD treatment. The situation in North America is far mo
re complex, with geographic areas and large population groups having l
ow levels of STD and others continuing to experience an epidemic of ST
D, particularly inner-city minority populations in the United States.
In developing countries both the prevalence and incidence of STD are s
till very high and STDs are a major public health problem making up th
e second cause of healthy life lost in women of 15 and 45 years of age
after maternal morbidity and mortality. ''Business as usual'' is clea
rly not acceptable any longer. A better understanding of the determina
nts of STD epidemiology is essential for a more effective approach to
STD control as well as recognizing the limitations of each single inte
rvention, be it medical or behavioral. The major challenges are to mob
ilize political commitment and funds, and to transfer small scale inte
rventions into large scale public health programs, and to apply the ri
ght mix of approaches, including medical, behavioral, societal interve
ntions.