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In countries where Médecins Sans Frontières works, the prevalence of sexually transmitted infections (STI) is very high. On a worldwide scale, the WHO estimates more than 340 million new cases of curable sexually transmitted infections each year for men and women aged between 15 and 49 years.
Women are more vulnerable to STIs than men. For social and physiological reasons women are more exposed to STIs than men. Diagnosis of STIs is also more complicated as in most women they are asymptomatic. In fact, around 70% of women with STIs present no symptoms at all (as opposed to only 10% of men). Furthermore, the consequences of STIs can be very serious for women, and sometimes fatal (cervical cancer, sterility, extra-uterine pregnancies, septicaemia). They can also be transmitted to the fetus resulting in miscarriages, stillbirths and neonatal deaths. Finally, genital tract infections are linked to increase risk of HIV transmission through the presence of an ulcer or discharge.
Read more on the feminisation of HIV/AIDS
In preventing and treating STIs Médecins Sans Frontières faces two major obstacles: stigma, which explains why patients hesitate to seek treatment and are reluctant to encourage their sexual partners to do the same; and diagnosis: the asymptomatic character of certain STIs and the absence of testing programmes or rapid, inexpensive diagnostic tests, leads to numerous people living with undetected, untreated infections which they continue to transmit.
Médecins Sans Frontières combines the diagnosis and effective treatment of sexually transmitted infections with information sessions including availability of testing for HIV, the promotion of condom use and an active partner tracing. Special attention is given to STIs in Médecins Sans Frontières’s prenatal consultations, family planning services and the framework of care offered to rape victims. When possible, diagnosis is confirmed by a laboratory test, however many of the currently available tests are not very sensitive or specific so they are not useful in the field. There are many new tests becoming available which will hopefully improve the management of infections in the field. Furthermore patients should be treated at their first encounter and not sent home to await results hence any tests need to give an immediate diagnosis. In the absence of rapidly available and reliable laboratory tests, the 'syndromic'* approach is used. Médecins Sans Frontières tries to ensure that effective drugs are used and where possible a single dose regimen is preferred in order to improve compliance (it’s easier to take a single treatment than a course over several days).
*In syndromic approach – patients with a consistent group of signs and symptoms are treated according to the most likely causative pathogens.