Sexual and Reproductive Health 5 Global control of sexually transmitted infections

Sexually transmitted infections other than HIV are important global health issues. They have, however, been neglected as a public-health priority and control eff orts continue to fail. Sexually transmitted infections, by their nature, aff ect individuals, who are part of partnerships and larger sexual networks, and in turn populations. We propose a framework of individual, partnership, and population levels for examining the eff ects of sexually transmitted infections and interventions to control them. At the individual level we have a range of eff ective diagnostic tests, treatments, and vaccines. These options are unavailable or inaccessible in many resource-poor settings, where syndromic management remains the core intervention for individual case management. At the partnership level, partner notifi cation and antenatal syphilis screening have the potential to prevent infection and re-infection. Interventions delivered to whole populations, or groups in whom the risks of infection and onward transmission are very high, have the greatest potential eff ect. Improvements to the infrastructure of treatment services can reduce the incidence of syphilis and gonorrhoea or urethritis. Strong evidence for the eff ectiveness of most other interventions on population-level outcomes is, however, scarce. Eff ective action requires a multifaceted approach including better basic epidemiological and surveillance data, high quality evidence about eff ectiveness of individual interventions and programmes, better methods to get eff ective interventions onto the policy agenda, and better advocacy and more commitment to get them implemented properly. We must not allow stigma, prejudice, and moral opposition to obstruct the goals of infectious disease control.