SEXUALLY-TRANSMITTED DISEASES IN THE 1990S - GLOBAL EPIDEMIOLOGY AND CHALLENGES FOR CONTROL

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.