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and responsibilities of public versus private health care professionals in STD prevention have not been clarified in light of recent changes in health care delivery and financing.

Given the above observations regarding STDs in the United States, the Institute of Medicine (IOM) convened the 15-member Committee on Prevention and Control of Sexually Transmitted Diseases in 1994 to “(a) examine the epidemiological dimensions of STDs in the United States and factors that contribute to the epidemic; (b) assess the effectiveness of current public health strategies and programs to prevent and control STDs;2 and (c) provide direction for future public health programs, policy, and research in STD prevention and control.3” The committee was charged to focus its study on STDs other than HIV infection.

BROAD SCOPE AND IMPACT OF STDS

The term “STD” is not specific for any one disease but denotes the more than 25 infectious organisms that are transmitted through sexual activity and the dozens of clinical syndromes that they cause.4 STDs are almost always transmitted from person to person by sexual intercourse.5 These infections are most efficiently transmitted by anal or vaginal intercourse, and generally less efficiently by oral intercourse. Some STDs, such as hepatitis B virus infection and HIV infection, are also transmitted by parenteral routes—particularly among intravenous drug users through contaminated injecting drug equipment. In addition, pregnant women with sexually transmitted infections may pass their infection to infants in the uterus, during birth, or through breast-feeding.

STDs are transmitted among all sexually active people, including heterosexual persons, men who have sex with men, and women who have sex with women (AMA, Council on Scientific Affairs, 1996). Men who have sex with men

2  

Although the committee examined the effectiveness of major strategies and programs in STD prevention, it did not conduct a systematic, in-depth evaluation of every STD-related program in the public and private sector. In this report, the committee focuses its discussions on effective strategies and highlights major effective programs.

3  

The terms “STD prevention” and “STD control” traditionally have been used by public health workers without clear distinction. These terms have been commonly used to refer to behavioral interventions (e.g., counseling for behavior change), treatment of symptomatic disease, and other interventions that prevent the spread of infection (e.g., partner notification). The committee believes that most interventions for STDs both “prevent” and “control” STDs and all prevent acquisition or transmission of STDs in a population. Essentially, effective prevention of STDs brings STDs under control. Therefore, in this Summary and the full report, the committee uses the term “STD prevention” rather than “STD prevention and control” to encompass all interventions, whether behavioral, curative, environmental, or otherwise, that are needed to reduce the spread of infection in a population.

4  

See Appendix A of the full report.

5  

The term “sexual intercourse” is used throughout this summary and the full report to refer to all forms of intercourse, including vaginal, anal, and oral intercourse.



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