1. STI testing in Europe, accessibility and availability I. Sziller 1 st Dept. Obstetrics and Gynecology, Semmelweis University Medical School

2. „Renaissance” of STI STI’s are of public health priority in their own right frequency potential morbidity

3. Significance of STI Late sequelae –infertility men/women –ectopic pregnancy –cervical cancer –premature mortality –congenital syphilis –fetal wastage –low birth weight/prematurity –ophtalmia neonatorum

4. Rate of ectopic pregnancy in Hungary (1931-2000)

5. „Renaissance” of STI A new pathogen (HIV) was needed to lead to urgent reappraisal of their control strategies

6. WHO UNAIDS - prevention of STI improves the health status, and prevents HIV transmission high priority to the development of appropriate programs WHO, 2002

7. EUROPE

8. Incidence of STI in reproductive ages, 1995

9. 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

10. 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

11. Syphilis Classic example of STI control by public health measures highly sensitive diagnostic test highly effective and affordable treatment

12. 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

13. 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

14. 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

15. 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

16. 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

17. Chlamydia Great differences between E & W recognition of the medical problem by health care authorities recognition of its public health importance

18. Prevalence among asymptomatic women

19. 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

20. 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

21. Trichomoniasis W. Europe 10 million new cases annually slight decline E. Europe 13 million new cases annually slight increase

22. 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.

23. 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