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Africa front cover for pdf Page 1 S EXUALLY T RANSMITTÅD I NFECTIONS 117 6 Sexually Transmitted Infectiîns "How long have you had this discharge?" asked the nurse. ÁA few weeêsÁ was the answer. "Does your husband have a discharge?" The answår was Áno,Á but the patient added that her husband was fråquently away from home on business. Out in this rural clinic, the nurse did not have diagnîstic equipment. She checked the algorithm for discharge and othår complaints. The woman's symptoms and risks were suspiciîus of a sexually trans mitted infection. She was treàted with spectinomycin. Sexually transmitted infections (STIs) are a major public health prob lem in Africa and now rank amîng the leading causes of illness in many Afriñan countries. 21,30 Like diarrheal disåase, malaria, measles, malnutrition, and tuberculosis, STIs are cîstly to society and result in increased health care eõpenditures and lowered levels of productiv ity. 21,37 STIs can lead to severe health consequences, especiàlly in women and children. 34,37 In addition, STIs fañilitate the transmission of human immunodeficiency virus (HIV). 36 Sequelae of STI include chronic pain, infårtility, ectopic pregnancy, and genital cancers in àdults and severe illness or death in newborns. Lîng-term conse quences of STIs are evident when examining pattårns of infertility in Africa. An estimated 85% of infertile Afriñan women have diagnoses attributable to a previous seõually transmitted infection, a percentage Page 2 118 F ÀMILY P LANNING M ETHODS AND P RACTICE : A FRICA marêedly higher than in other regions of the world. 7 In pàrts of sub Saharan Africa, where STI prevalence is high, as many as 30% to 50% of couples may be infertile. 37 Because most women attånding family planning centers are at risk for both prågnancy and STIs, family planning clinicians can sårve an important role in preventing STIs. 10,20 Îften, the family planning clinic is the only health care prîvider routinely seen by clients at risk for STI. Thus, family plànning clinicians must be able to diagnose and treat STIs in their cliånts. The World Health Organization (WHO) has distillåd practical considerations in case management for STI con trol into four briåf recommendations that can guide family planning cliniciàns: 39 Á Educate persons at risk on the modes of disåase transmission and the means of reducing the risk of transmission. Á Dåtect infection in asymptomatic persons and in persons who are symptomàtic but unlikely to seek diagnostic and therapeutic services. Á Effåctively manage persons who are infected. Á Treat and eduñate sex partners of persons with an STI. In this chapter, we provide generàl background about STI man agement in the family plànning setting and review current approaches to diagnîsing and treating the most common STIs