STI Programs in Asia: STI Surveillance and Interventions for HIV Prevention

FHI Thailand

Emerging Roles of STI Services in Asia. Interesting brand new data was presented from two contrasting countries of the former Indochina: Laos and Cambodia. Laos has just implemented their first round of HIV sentinel surveillance. Gonorrhoea was absent from all women in a recent big study of the general population and Chlamydia was low. Among so called service workers or hospitality based sex workers, HIV was under one per cent and syphilis was extremely low. Laos clearly has a nascent HIV epidemic. In Cambodia, on the other hand, a recent study in sex workers showed that gonorrhoea, Chlamydia, and syphilis were high in sex workers and low in antenatal clinic attendees. There is limited evidence that sexually transmitted diseases may be decreasing in both women sex workers and women who do not practice transactional sex.

Studies among Nepali sex workers, sex workers in Cambodia, and sex workers in Andhra Pradesh in India demonstrated that the ulcerative sexually transmitted disease syphilis is a predictor of HIV infection. Now that it is known that women in the general population have few STIs and that sex workers have many, how can STIs in sex workers be diagnosed and treated? And how can women in the general population who have vaginal discharge get diagnosis and treatment for their non-sexually transmitted vaginal infections? A study in Manila showed that current clinical practice of using microscopy for vaginal discharge was effective for women in the general population. Syndromic management was not. This was confirmed in Cambodia and Indonesia. So where do we go from here? Use microscopy for vaginal symptoms in women who have one sexual partner. Provide user-friendly services for sex workers where they can be treated for syphilis and Chlamydia and perhaps gonorrhoea.