Sexually transmitted infections (STIs) present a large burden of disease and debility. As per a recent STI prevalence study (2003), over five percent of adult population in the country suffers from STIs.

It is established that the risk of acquiring HIV infection increases manifold in people with current or prior STI. A certain sexual behaviour puts people at the risk of acquiring STI and HIV infection. Once infected by sexually transmitted disease, a person has increased chances of acquiring and transmitting HIV. This is corroborated by high HIV prevalence rates among clients of sex workers: 22.8 percent in Andhra Pradesh, 15.2 percent in Maharashtra, 12.2 percent in Manipur and 7.4 percent in Delhi. The emergence of HIV and identification of STIs as a co-factor have lent a sense of urgency for formulating a programmatic response to address this public health concern.

Besides HIV, RTIs including STIs cause suffering for both men and women around the world, but their consequences are far more devastating and widespread among women than men. These infections often go undiagnosed and untreated. If left untreated, they lead to complications such as infertility, ectopic pregnancy and cervical cancer.  Pelvic inflammatory disease arising from STIs poses a major public health problem and adversely affects the reproductive health of poor and untreated women. Contraceptive acceptance and continuation is also compromised by the presence of STIs. Similarly some of the RTIs are associated with poor pregnancy outcome and high morbidities and mortalities in neonates and infants.

In developing countries the incidence and prevalence of RTIs/STIs are very high; they rank second as the cause of healthy life lost among women of reproductive age group, after maternal morbidity and mortality. In men, STIs combined with HIV infection account for nearly 15 percent of all healthy life lost in the same age group.

Programmatic response to address prevention, management and control of RTIs/STIs largely falls under the National Reproductive and Child Health (RCH-II) Programme, which was launched in 2005. The programme draws its mandate from the National Population Policy (2000), which makes a strong reference to “include STD/RTI and HIV/AIDS prevention, screening and management in maternal and child health services”.

For prevention of HIV/AIDS, therefore, services for management of STIs are given greater impetus under the National AIDS Control Programme III (NACP- III). The Strategy and Implementation Plan (2006-2011) makes a strong reference for expanding the access to package of STI management services both in general population groups and for high-risk groups.  The programme acknowledges that expanding access to services will entail engaging private sector in provision of services. Several studies indicate client preference to access services from private providers. The programme thus envisages to link treatment facilities in both public and private sector to target high-risk groups.

Clinical Spectrum of RTIs/STIs

Clients suspected of having RTIs/STIs usually present with one or more of the following complaints:

1.       Vaginal or urethral discharge

2.       Genital ulcers

3.       Inguinal bubo

4.       Lower abdominal and/or scrotal pain

5.      Genital skin conditions.