Moving ahead on elimination of sexually transmitted infections (STIs) in WHO South-East Asia Region - progress and challenges
Overview
This rapid assessment of the sexually transmitted infection (STI) epidemiology and response in the World Health Organization (WHO) South-East Asia (SEA) Region was conducted in April/May 2018. Methods included structured interviews with programme managers and WHO focal points, review of the literature, and trend analysis of available routine reporting data. The primary focus was on the control of common curable STIs – syphilis, gonorrhoea, chlamydia, chancroid, and trichomoniasis. Epidemiological interaction and programme overlap with viral STIs, including human immunodeficiency virus (HIV), hepatitis B and C, herpes virus, and human papillomavirus, are addressed elsewhere.
Historically, STIs have been among the most serious public health problems in the WHO SEA Region, with high associated morbidity, mortality, disability, and adverse pregnancy outcomes. WHO estimated that SEA Region countries accounted for more than a third of all new STI infections globally in the mid-1990s. The incidence and prevalence of curable STIs, notably ulcerative chancroid and syphilis, were extremely high in urban areas and along well-travelled migrant and trucking networks, and closely linked to the rapid early spread of HIV. Where measured, rates of gonococcal, chlamydial, and trichomonal infections were often even higher. However, large-scale interventions with a package of services, including the promotion of condom use in sex work, led to major declines in STIs and slowing of HIV epidemics during the 1990s and early 2000s, notably in Thailand and parts of India.
Perhaps the greatest overall impact on regional STI epidemiology was achieved during the past 15 years, following marked progress in India, which accounts for over two-thirds of the Region’s population. During this period, interventions to reduce HIV/STI transmission among key and bridge populations were scaled up, and large STI declines in the most highly affected states were documented. WHO estimates that the SEA Region’s share of new STI infections globally was only 11% in 2012—less than a third of what it was in the late 1990s.
Currently, the epidemiology of STIs in the Region remains highly heterogeneous. Very low STI incidence and prevalence have been maintained over several decades in Sri Lanka and Thailand, while much higher and variable rates are reported elsewhere. Thailand and Maldives have been certified as having eliminated mother-to-child transmission of both syphilis and HIV, while Sri Lanka is preparing for validation of the same. Yet, insufficient data on STIs limit assessment of the epidemiological situation in most other countries, hindering control efforts.
