Prevention and control of STDs is based on five main concepts: first, educating people who are at risk for preventing STDs; second, the identification of asymptomatically infected individuals or those who have symptoms of an STD, but most likely will not seek medical help from a medical institution; thirdly, the effective diagnosis and treatment of infected persons; Fourthly, examination, treatment and counseling of sexual partners of persons with STDs; Fifth, the provision of preventive vaccination to persons at risk. Although this paper focuses on secondary prevention, that is, the clinical aspects of STD control, the main way to prevent STDs is to change the sexual behavior of patients. Moreover, since STD control reduces the probability of transmission of infection to a partner, the result of measures to prevent infection of individuals is the prevention of the incidence of society as a whole.
Doctors and other health professionals play an important role in the prevention of STDs. In addition, by treating patients with STDs caused by bacteria or protozoa in order to interrupt further transmission of infection, clinicians are able to provide education and counseling to patients and participate in the identification and treatment of infected sexual partners. The ability of a medical worker to collect an accurate anamnesis of the patient's sexual life is extremely important in carrying out preventive work. Recommendations on this issue are given in the section on "Sexuality and reproductive health" in the manual "Technology of contraception". The setting of an accurate diagnosis and timely submission of information about it by doctors is the basis for the effectiveness of the supervision service.
Recommendations for patients on STD prevention
To prevent the spread of STDs, it is necessary that individuals at risk of transmitting or acquiring a disease change their behavior. The first necessary step in this direction is the inclusion in the development of an anamnesis of correctly formulated questions concerning the sexual life of the patient. When risk factors are established, the health worker can give recommendations on the prevention of STDs. In order for recommendations to be effective, communication skills (for example, the ability to show respect, compassion and not to condemn) are necessary. An effective method of communicating with the patient involves the use of open questions and terms that the patient understands, as well as the patient's assurance that the treatment will be provided regardless of his solvency, citizenship, immigration status, the language he speaks or his way of life.
When conducting a conversation, it is necessary to take into account the risk factors specifically for this patient. It is necessary to describe the specific actions that the patient should take to avoid infection or spread of STDs (including abstinence from sex if he has symptoms of STDs).
Sexually transmitted infection
The most effective way to prevent sexual transmission of HIV and other STDs is to abstain from sexual contact with infected partners. It should be recommended to refrain from penetrating types of sexual intercourse to persons who are treated for STDs or whose partners are treated for STDs, as well as to persons who want to avoid the consequences of sexual intercourse (ie, infection with STD / HIV and pregnancy). A more detailed discussion on abstinence is outlined in "Contraceptive Technology".
Both partners should be tested for STDs and HIV before they have sexual intercourse.
If a person prefers to have sex with a partner whose infectious status is unknown, or with someone who is infected with HIV or other STDs, he should use a new latex condom for each sexual intercourse.
Persons who use drugs intravenously
Recommendations for drug abusers using intravenous drugs (CNV) are as follows:
Start or continue the program of treatment for drug dependence.
Under no circumstances should you use injection tools (syringes, needles) if they have already been used by another person.
If there is a needle exchange program in the area, you need to get clean needles.
Persons who continue to use syringes or needles that have already been used should first of all clean them with bleach and water. (Chlorine lime disinfection does not sterilize equipment and does not guarantee the inactivation of HIV, but the constant cleaning of injection tools will reduce the level of HIV transmission if the tools are used by different people).
Preventive vaccination is one of the most effective methods of preventing the transmission of certain STDs. Infection caused by the hepatitis B virus is often sexually transmitted and hepatitis B vaccination is recommended for all unvaccinated patients undergoing STD screening. Recently, vaccines against hepatitis A, manufactured by two manufacturing companies, have been licensed in the United States. Vaccination against hepatitis A is recommended for several groups of patients who can visit the STD clinic, including homosexual and bisexual men, as well as people who use drugs. Vaccines are being tested against other STDs, the practical use of which can begin in the next few years.
Methods for preventing STDs / HIV
With consistent and proper use, condoms are a highly effective means of preventing various STDs, including HIV infection. Numerous cohort studies, including studies of serodiscordant pairs, showed a pronounced protective effect of condoms in HIV infection. Since condoms do not cover the entire surface exposed to the risk of infection, they are more effective in preventing infections transmitted by contact with mucous membranes than those that are infected by contact with skin surfaces. Condoms refer to medical devices and are checked by the FDA. The integrity of each latex condom produced in the US is examined by electronic devices before packaging. In the US, the frequency of condom breaks during use is low (2 per 100). Failures in the use of condoms are usually the result of intermittent or misuse, rather than a condom break.
To effectively prevent STDs, patients should be encouraged to use condoms consistently and correctly. Patients should also be instructed on how to use the condom correctly. The following recommendations will make it possible to correctly apply the male condom:
Use only a new condom every time you have intercourse.
Handle the condom carefully to avoid damage to the nails, teeth or other sharp objects.
Wear a condom on the penis in a state of erection and before any genital contact with a partner.
Make sure that there is no air at the end of the condom.
Make sure that you have enough lubricant during the sexual act, you may need additional use of lubricants.
Use only water-based lubricants with latex condoms (eg KY Jelly ™ or glycerin). Do not use oil-based lubricants (eg, petroleum jelly, mineral oils, massage creams, body lotions or cooking oils), since they destroy latex.
To avoid slipping after intercourse, it is necessary to firmly hold the condom at the base of the penis while removing it and remove it while the penis is in an erection state.
Laboratory studies have shown that the female condom (Reality ™) - a smeared polyurethane shell with a ring at both ends, placed in the vagina - is a reliable mechanical barrier for viruses, including HIV. In addition to small studies on trichomoniasis, clinical studies to evaluate the effectiveness of female condoms to prevent HIV infection and other STDs have not been completed. With consistent and proper use, female condoms should significantly reduce the risk of STDs. In a situation where you can not use a male condom, the couple should use a female condom.
Condoms and spermicides
Data showing that condoms lubricated with spermicides are more effective in preventing transmission of HIV infection and other STDs than condoms with any other lubricants are not. In addition, the use of condoms covered with spermicides is associated with infection of the urinary tract of Echehchia coli in young women. There is no data showing whether use of condoms with spermicide application is more effective than using condoms without spermicides. Therefore, the correct use of condoms without lubricants, as well as with spermicide lubricants or with the introduction of spermicides into the vagina is recommended.
Vaginal spermicides, sponges and diaphragms
As shown in several randomized, controlled trials, vaginal spermicides used without a condom reduced the risk of cervical gonorrhea and chlamydia. However, they do not have a protective effect against HIV infection, therefore it is not recommended to use spermicides to prevent HIV infection. Vaginal contraceptive sponges protect against cervical gonorrhea and chlamydia, but when used, the risk of candidiasis increases. When using a diaphragm, a protective effect against cervical gonorrhea, chlamydia and trichomoniasis is shown, but only in cross-sectional and case-control studies, and no cohort studies have been performed. To protect women from HIV infection, vaginal spermicides, sponges or The role of spermicides, sponges, diaphragms to prevent STDs in men has not been studied.
Women who do not have the risk of becoming pregnant can unreasonably believe that they can not become infected with STDs, including HIV. Non-barrier methods of contraception do not protect against STDs or HIV. Hormonal contraceptives (oral contraceptives, Norplant, Depo-Provera) have been associated in several cohort studies with an increased incidence of cervical STDs and HIV infection, but these facts are not confirmed in all studies. It is necessary to advise women who use hormonal contraception (oral contraceptives, norplant ™, Depo-Provera ™) who underwent surgical sterilization or hysterectomy, regarding the use of condoms, and the current risk of STDs, including HIV infection.
Advice on HIV prevention
Elucidation of HIV status and appropriate counseling play an important role in motivating behavior change. Therefore, counseling on HIV prevention is considered very important in the strategy to prevent the spread of HIV, although its effectiveness in reducing the risk in behavior can not be accurately assessed. Convinced that the counseling has been successful and the patient is properly oriented, the health worker will be able to correctly assess the risk of the patient and help him to develop an individual and realistic plan for preventing HIV infection.
Counseling in HIV testing consists of two main stages: counseling before and after testing. During counseling, before the test, the health worker should assess the patient's individual risk, explain the significance of positive and negative test results, obtain informal consent for testing, and help the patient develop a realistic personal risk reduction plan. During counseling after the test, the health worker should inform the patient of the test results, explain the significance of the findings and preventive recommendations. If the result of the test is positive, when consulting after testing, it is necessary to discuss the referral to medical institutions for follow-up and, if necessary, social protection and psychological support services. For HIV-seronegative patients who are at risk of contracting HIV infection, referral to other counseling services or prevention services can also be helpful.
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"