Reproductive Health (Ebert)

REPRODUCTIVE HEALTH PROGRAM (EBERT)
Reproductive Tract Infections and Sexually Transmitted Infections

The Population Council’s work on reproductive tract infections (RTIs), including sexually transmitted infections (STIs), consists of two complementary aspects: management of RTIs/STIs in resource-poor settings and development and promotion of female-controlled prevention methods.

For close to 15 years, Population Council researchers have been working to draw attention to the severe limitations of available HIV/STI prevention options for women. This work has been instrumental in inspiring a major effort to develop vaginal microbicides, and the Population Council has been at the forefront of both product development and policy discourse on this technology.

At the same time, Council staff members have been working to critically assess some of the approaches that have been used to manage RTIs/STIs in women and continue to experiment with developing alternatives to the less-than-perfect current strategies. The Council’s research examines social factors that may affect the acceptability of prevention technologies such as preferences for lubrication during sex, intravaginal practices, and semen-loss concerns.

Alternative technologies to assess RTIs/STIs
Limited access to screening programs for reproductive tract infections, and low use of these services in areas where they are available, result in large numbers of women living with undiagnosed reproductive tract infections in many developing country settings. Reliance on syndromic management (the diagnosis and management of disease based on symptoms and/or clinical inspection, without laboratory testing) of RTIs for women who do present at clinics further compounds the problem, as asymptomatic women often leave the clinics without diagnosis and treatment.

Population Council researchers are currently exploring two technologies that could help to increase the number of women screened and accurately diagnosed and treated in resource-poor settings. Studies are evaluating self-sampling methods (women insert vaginal swabs or tampons themselves to be used for RTI diagnosis) and rapid diagnostic tests (rapid point-of-service tests), which provide same-day test results and can be used at home or at the clinic, similar to home pregnancy tests. Enabling women to take their own samples at home could increase the use of screening services, as both going to the clinic and undergoing a pelvic exam can serve as disincentives to seeking care. Giving women the opportunity to use rapid diagnostic tests at home could further increase the number of women screened for RTIs, in part by decreasing the waiting period for test results.

The introduction of rapid diagnostic tests in clinics could increase the accuracy of screening procedures, requiring less reliance on syndromic management for vaginal discharge for women attending clinics, which do not have access to laboratory facilities. The Population Council is exploring the use of these technologies in different regions to show variation in acceptability and validity due to cultural differences as well as to differences in the prevalence of reproductive tract infections. A study that was conducted in Gugulethu, South Africa, in collaboration with the University of Cape Town (UCT), demonstrated that self-sampling methods are feasible, valid, and acceptable methods for the diagnosis of most RTIs, including chlamydia, gonorrhea, bacterial vaginosis, yeasts, and HPV. However, when using culture to detect trichomoniasis vaginitis (TV), self-sampling methods cannot be recommended.

Male involvement in STI prevention
The Population Council has also been involved in exploring ways in which men can be directly involved in the prevention of STIs, including HIV/AIDS. To that end, the Council supported a monograph on male semen loss concerns and its relation to STI/HIV interventions, produced by Deepak Charitable Trust in India. Prior research in India found widespread belief that semen is a vital bodily force and that losing semen other than through sexual intercourse results in a loss of physical and sexual strength. This belief may discourage men from using safer sexual practices, such as masturbation, limiting the number of sex partners, and/or using condoms. The dissemination of the publication will foster public discussion of issues that are usually taboo or deeply closeted, and lead to the development of strategies to involve men in reproductive and sexual health programs aimed at decreasing the transmission of STIs. [For more information, or to obtain the monograph, contact: Deepak Charitable Trust, deepakfoundation@yahoo.com.]

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This page updated
29 July 2005