STI management and control in North America IUSTI region

INTRODUCTION In the USA, approximately 19 million new cases of sexually transmitted infections (STIs) occur annually, primarily affecting adolescents and young adults. Direct and indirect costs to the USA for STIs are estimated to be $10e17 billion dollars per year (table 1). Issues of health inequity and health disparities make STIs a prime target for management and control. STIs present numerous barriers to routine clinical care and diagnosis because of the associated stigma, costs and confidentiality issues. Furthermore, even if tested, many infected patients (30%e74%) never return for routine test results or are lost to follow-up for treatment. In Canada, between 1997 and 2007, both the number and rate of reported cases increased for chlamydia, gonorrhoea and infectious syphilis. All three STIs increased more dramatically among middle-aged adults.