Sexually Transmitted Diseases (STDs): Definition And Spread In The World
Sexually transmitted diseases (STDs) are conditions caused by pathogens like bacteria, viruses, protozoa, fungi, and ectoparasites. These infections can mostly be transfer from person to person through unprotected sexual intercourse. They can also be passed through anal sex, oral sex or skin-to-skin contact (1). Some STIs can also be spread through non-sexual means such as via blood or blood products. Many STIs including syphilis, hepatitis B, HIV, chlamydia, gonorrhea, herpes, and HPV can also be transmitted from mother to child during pregnancy and childbirth (2). STDs are known for causing a variety of clinical syndromes, including abnormal genital discharge, genital ulcer/sore, inguinal bubo, and lower abdominal pain in females (3).
Every day, there are more than 1 million new cases of curable sexually transmitted infections (STIs) among people aged 15-49 years (4). This amounts to more than 376 million new cases annually of four infections – chlamydia, gonorrhea, trichomoniasis, and syphilis. These STIs have a profound impact on the health of adults and children worldwide. If untreated, they can lead to serious and chronic health effects that include neurological and cardiovascular disease, infertility, ectopic pregnancy, stillbirths, and increased risk of HIV. Moreover, STI increases the risk of having HIV two fivefold. They are also associated with significant levels of stigma and domestic violence (5).
The WHO Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021 has outlined the goals and targets for global STI prevention and control. The first strategic direction is to collect information on STI prevalence and incidence among the Key population(6). Unlike other developing countries, sexually transmitted infections (STIs) and reproductive tract infections (RTIs) represent a major public health problem in Bangladesh (7). Women working in bars, hotels and other food and recreational facilities have been documented to have a higher risk of STIs, including HIV, than the general population. Female sex workers (FSWs) are particularly at risk for STIs and HIV. They often are infected by their clients and subsequently transmit the infection to other partners. It has earlier been demonstrated that in most parts of Asia and Africa, 60 to 70% of the STIs relate to clients of FSWs and sexual networks (8).
The number of FSWs in Bangladesh is unknown, but estimates range from 50,000 to 100,000. FSWs work in brothels, streets, hotels, and residences. However, in recent years there has been a remarkable change in the nature of the sex industry, possibly due to eviction of brothels from major cities, increased demand for sex workers in nonstigmatized locations, demand for flexible working times by sex workers and demands for more freedom and opportunity of income by FSWs (9).
Surveillance data show that hotel-based sex workers (HBSWs) have a higher client turnover than their peers on the streets and in brothels, while the payment per client is considerably higher than that in brothels or on the street. As a result, HBSWs have a much higher income than brothel- and street-based sex workers on average. Because of their high client turnover and low condom rate of use, the vulnerability of HBSWs to STIs and HIV was believed to be very high. Hotel-based sex work is common in many Southeast Asian countries, including Bangladesh. Although there is little information regarding the prevalence of STIs among street-based, brothel-based and hotel based FSWs in Bangladesh.(8)
However, several recent papers have reported relatively poor performance of this approach among women due to most infections being asymptomatic. Better knowledge of the epidemiology of STIs among women who are most vulnerable to these infections may lead to improved treatment policies and prevention programs to reduce their burden and mitigate subsequent reproductive health problems. In resource-poor, primary care settings, diagnostic facilities to aid the effective management of reproductive tract infections (RTIs) may not be available, and so algorithms based on signs and symptoms of infection are relied upon. The World Health Organization recommends that guidelines are adapted according to local factors such as the prevalence of disease and microbial resistance patterns.
Sexually transmitted infections (STIs), including HIV, continue to present major health, social, and economic problems in the developing world, leading to considerable morbidity, mortality, and stigma. The prevalence rates apparently area unit so much higher in developing countries wherever STD treatment is a smaller amount accessible. Association of HIV and STIs has light-emitting diode to common management ways for each. The amendment within the incidence and prevalence of HIV is extraordinarily tough to observe.However, the prevalence and incidence of some STIs, which are curable, change quickly and can be used as a proxy marker for changes in sexual behavior and, ultimately, the HIV incidence. Sex workers are one of the core groups for the transmission of STDs and HIV as a ‘bridge group’ to the general population(11). Accordingly, the highest priority is given to this group in targeted intervention for the prevention of HIV/AIDS. A study in Surat India showed that 58.8% of FSWs do not complain about genitourinary problems willingly and some of them remain asymptomatic also. This causes underdiagnosis of the STI problems. The most common complaint was Lower abdominal pain associated with vaginal discharge. 46.7% of FSWs had no history of sexually transmitted diseases before. 41.1% of FSW had one or more signs that suggest STI. The percentage of the genital ulcer was very less that is 5.9% (12).
Sexually transmitted infections can cause major health problems if left untreated. Untreated microorganism STDs in females lead to pelvic inflammatory disease in up to 40% of infections, and one in each 3 of those can lead to sterility. Tubal damage from STDs can lead to ectopic (tubal) pregnancy, which can result in up to 10% of maternal mortality in settings where the prevalence of STDs is high (13). Chronic pelvic pain from untreated bacterial STDs is an important reason for health care visits among females. STDs are also among the leading causes of disability-adjusted life years lost for females of reproductive age in the developing countries (14). A study was done in Ethiopia a community-based study they did the study on 389 female sex workers and found that sex workers who had sex with their paying clients without a condom were four times more likely to have STDs. They found the prevalence rate of sexually transmitted disease 20.6% whereas another study conducted in Malawi has found the prevalence rate of 20% which is quite similar(3). Another study in Ethiopia found that the prevalence of sexually transmitted disease prevalence was 47.9%(15).
A study was conducted among hotel based commercial sex workers in Dhaka, Bangladesh the author found a prevalence of at least one RTI (bacterial vaginosis or Candida albicans) was 68.8%. The prevalence of at least one STI or RTI was 86.8%. The prevalence of at least one, two, and three STIs (e.g., gonorrhea, chlamydial infection, trichomoniasis, and/or syphilis) among HBSWs were 63.3, 25.5, and 3.5% respectively. The threat of HIV epidemic is looming over Asian nation, as STIs and risk behavior levels are found to be high. In Bangladesh, the primary HIV case was detected in 1989. HIV prevalence remains less than 0.01% among the general population. HIV prevalence remains about 3.9% among the key population mostly in PWID. The estimated number of People Living with HIV is 14,000.
Bangladesh has maintained a low national HIV prevalence in the general population. According to the National Surveillance of 2015-16, a concentrated epidemic has been recorded among the male PWID in a neighborhood of Dhaka (Old Dhaka) where the prevalence was 27.3% and it was 8.9% in the rest of Dhaka. In female PWID in Dhaka, the prevalence of HIV was 5%. Till now, the prevalence of HIV among FSWs, MSM, MSWs is less than 1%. No HIV was detected among male PWID in Hili (a small border town in the Northwestern part of Bangladesh bordering the Indian State of West Bengal) but of 46 Hijra sampled in Hili two were positive for HIV (4.3%) while 0.9% were positive in Dhaka.
Outside of Dhaka, HIV prevalence at or above 1% was documented among male PWID in Narayanganj (1.5%); females who use drugs in Dhaka/Tongi/Narayanganj (1.2%), females who use drugs in Benapole (1.0%); and casual FSW in Hili (1.6%) in the National Surveillance of 2011(10).
Surrogate markers of risk which include hepatitis C (HCV) rates for unsafe injection and active syphilis for unsafe sex are also measured. HCV among PWID was measured in 2011 and the rates varied in different geographical areas: HCV prevalence ≥30% was detected in 10 cities including Dhaka where the rate declined significantly over the years from 66.5% in 2000 to 39.6% in 2011.