sti testing in europe, accessibility and availability i. sziller 1 st dept. obstetrics and...
Post on 18-Dec-2015
215 views
TRANSCRIPT
![Page 1: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/1.jpg)
STI testing in Europe, accessibility and availability
I. Sziller1st Dept. Obstetrics and Gynecology, Semmelweis
University Medical School
![Page 2: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/2.jpg)
„Renaissance” of STI
• STI’s are of public health priority in their own right
• frequency
• potential morbidity
![Page 3: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/3.jpg)
Significance of STI
• Late sequelae– infertility men/women
– ectopic pregnancy
– cervical cancer
– premature mortality
– congenital syphilis
– fetal wastage
– low birth weight/prematurity
– ophtalmia neonatorum
![Page 4: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/4.jpg)
Rate of ectopic pregnancy in Hungary (1931-2000)
![Page 5: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/5.jpg)
„Renaissance” of STI
• A new pathogen (HIV) was needed to lead to urgent reappraisal of their control strategies
![Page 6: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/6.jpg)
WHO
• UNAIDS - prevention of STI
• improves the health status, and
• prevents HIV transmission
• high priority to the development of appropriate programs
WHO, 2002
![Page 7: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/7.jpg)
EUROPE
![Page 8: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/8.jpg)
Incidence of STI in reproductive ages, 1995
Region new cases/year(x1000)
incidence/100015-49 year old
N. America 14.000 91
W. Europe 16.000 77
E. Europe 18.000 112
S/SE Asia 150.000 160
Total 333.000 113
![Page 9: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/9.jpg)
Differences between E & W
• Failure to recognize the problem
• diagnosis of symptomatic patients
• STD clinics only• inadequate coverage
• stigmatization
• low cost antibiotics
• missing education/prevention
• Recognition of the problem
• identification of asymptomatic patients
• interdisciplinary diagnosis• wider coverage
• no stigmatization
• antibiotics
• education/primary & secondary prevention
![Page 10: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/10.jpg)
Care for STI’s
• Two sides of the coin
• availability– diagnostic procedures: quality and quantity
– treatment: effectiveness, cost
• accessibility– the population to be tested/screened
» appropriate population?
– public health service
![Page 11: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/11.jpg)
Syphilis
• Classic example of STI
• control by public health measures
• highly sensitive diagnostic test
• highly effective and affordable treatment
![Page 12: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/12.jpg)
Syphilis
W. Europe
• peak after II. World War
• decline of incidence to 5/100.000
E. Europe
• peak after II. World War
• decline until 1990
• since that time alarming increase to 120-170/100.000 in 1996 in the former soviet countries
![Page 13: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/13.jpg)
Gonorrhoea
• Basic facts– common STI
– 80% of infected women, 10% infected men asymptomatic
• Diagnosis– needs sophisticated equipment
– costly, not available in some countries
• Treatment– effective, affordable
![Page 14: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/14.jpg)
Gonorrhoea
W. Europe
• decline 1980-1991 to below 20/100.000
• from 1990, 30-35% increase in England/Wales, Sweden, etc.
E. Europe
• decline until early 1990’s
• substantial increase to 111-139/100.000 in Baltic countries
![Page 15: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/15.jpg)
Control of gonorrhoea
• Accessibility
– public health advantage in communities where testing/screening policy covers a broad spectrum of pts
» university clinics, family planning clinics
– higher or increasing rates in communities where STD or VD clinics only
![Page 16: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/16.jpg)
Chlamydia
• Basic facts• common cause of cervicitis/urethritis, and PID• subsequent risk for infertility
• Diagnosis• sensitive but costly methods• significant differences among W. European countries
and between E-W Europe
• Treatment• effective and costly
![Page 17: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/17.jpg)
Chlamydia
• Great differences between E & W
• recognition of the medical problem by health care authorities
• recognition of its public health importance
![Page 18: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/18.jpg)
Prevalence among asymptomatic women
Iceland 8.0
Denmark 6.7
UK 6.2
Hungary 5.4
The Nederlands 4.9
France 3.9
Italy 2.7
![Page 19: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/19.jpg)
Chlamydia
W. Europe– wide coverage for
Chlamydia testing
– screening programs in the early 1970’s in some countries
– falling rates of new cases and late consequences
E. Europe– narrow coverage for
Chlamydia testing
– no screening programs
– increasing incidences and late consequences
![Page 20: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/20.jpg)
Trichomoniasis
• Basic facts• the most common STI, limited data
• increased HIV virus seroconversion
• adverse pregnancy outcome
• Diagnosis• effective, available, accessible
• Treatment• effective, low cost
• resistant cases
![Page 21: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/21.jpg)
Trichomoniasis
W. Europe
• 10 million new cases annually
• slight decline
E. Europe
• 13 million new cases annually
• slight increase
![Page 22: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/22.jpg)
Conclusions
• Significant differences between E & W Europe with regard to STI’s
• marker of differences between health care status of the two sub-regions
» cardivascular diseases
» malignant diseases
» life expectancy, etc.
![Page 23: STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School](https://reader030.vdocuments.site/reader030/viewer/2022032800/56649d235503460f949fa236/html5/thumbnails/23.jpg)
Conclusions
• Future prospects• national programs in all countries
• inclusion of not only classic STI’s and HIV/AIDS
• screening programs
• education
• promotion of use of barrier methods
• availability
• accessibility