Sexually transmitted diseases (STDs)other than HIV infection

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Why. Early identification of most STDs other than HIV infection is of proven effectiveness in reducing morbidity and is though to reduce further spread. Many STDs are asymptomatic until serious health damage has occurred and are also highly contagious, even when asymptomatic. STDs other than HIV infection and hepatitis B are generally curable with relatively simple treatments when detected opportunely.
Who and when. Regular screening of high-risk groups . intervals between screening will depend on local resources and the education and motivation of the population at risk. groups generally at high risk include heterosexuals with a number of partners or whose partners have a number of partners , homosexual or bisexual men, and prostitutes. In some areas, the criteria for high risk may be broader (see earlier recommendations for screening pregnant woman and adolescents for STDs .
How and where. Definitive diagnosis of STDs requires laboratory facilities and thus ,even if primary care workers can be trained to take specimens, involves the use of technically trained personnel. While screening may be carried out at a peripheral health post, the processing of specimens will involve at least the resources of a health centre with a laboratory, and potentially the resources of a district laboratory. Communication system s are ceded for sending specimens, ensuring timely delivery of results, notification of patients, and appropriate treatment and follow-up , with preservation of confidentiality throughout.
The presence of one STD generally indicates the need to consider others that are prevalent in the area. Chlamydia trachomatis infection has become more prevalent than gonorrhea in many areas. Although cheaper antibody-based methods have recently been developed for Chlamydia screening (Trachtenberg et al ,1988), the expense of accurate Chlamydia screening may necessitate, in most places, giving presumptive treatment for Chlamydia to persons with culture-proven gonorrhea or relevant physical signs or symptoms or history (USPSTF,1989).
Hepatitis B can be sexually transmitted and carriers may be asymptomatic . homosexual and bisexual men, the female partners of bisexual men, prostitutes, use of intravenous drugs, and people who have received injections in unhygienic conditions are at risk. Unlike most other STDs, hepatitis B is not curable. The goal of screening would therefore be to reduce the likelihood of transmission; there is no evidence of the effectiveness of such an approach, compared with efforts to promote safe sexual practice.
Resource levels required. Low (enquiries regarding symptoms or risk factors)or medium to high (laboratory testing)for detection; low or medium for treatment of bacterial infections (antibiotics)and promotion of safe sex to prevent spread of disease and reinfection.

Recommendation on use of screening early detection. Recommended to screen high-risk groups and pregnant women, confidentially and with informed consent. Early detection through opportunistic screening (for symptoms, exposure, or risk of exposure, or risk of exposure)is recommended, as is education for self-referral on the bases of potential exposure . screening should be seen as an adjunct to other preventive activities, including public education on the prevention of STDs, the promotion of safe sexual practices, and the encouragement of self-referral for signs or symptoms of STDs or possible exposure to them. Services for screening, diagnoses, and treatment need to be confidential  and readily accessible with special attection to the needs and preferences of the groups at highest risk. 

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