Sexually Transmitted Infections: Impact and Cost-Effectiveness of Prevention

Authors: Harrell W. Chesson, Philippe Mayaud, Sevgi O. Aral

Sexually transmitted infections (STIs) increased by over 11 percent from 2005 to 2008, with low- and middle-income countries (LMICs) bearing a higher burden of the increase than high-income countries (HICs). STI consequences may lead to reproductive disorders, infant infections, liver failure, cancer, and nervous system disease. Factors affecting duration and burden show that significant changes have occurred in sexual behaviors and practices, epidemiology, and prevention. One key population, men having sex with men, has been understudied and underserved. Given the success of biomedical interventions for HIV/AIDS, the field of STI prevention is drawing increasingly on biomedical interventions. The interventions most studied for effectiveness include condom use, male circumcision, HPV vaccines, and microbicides. The cost-effectiveness of STI prevention interventions depends in part on the degree to which reductions in STIs might influence the HIV epidemic. Priorities for global STI research remain since underutilization of effective and cost-effective interventions highlights the need for more health services research and stronger health systems.