engleski

Challenges and opportunities in STI case management in Croatia

Sexually transmitted infections (STIs) including HIV/AIDS are one of the most important public health issues in the World today. The World Health Organization (WHO) estimates that every year more than 340 million new cases of common sexually transmitted infections (i.e. syphilis, gonorrhoea, chlamydial genital infections, HPV and trichomoniasis) occur throughout the world in men and women aged 15-49 years. In order to address this issue, in May 2006, WHO approved the Global Strategy for the Prevention and control of sexually transmitted infections: 2006− 2015. The most-at-risk populations for STIs and HIV are often the same and include: men who have sex with men (MSM), injecting drug users (IDU) and their sexual partners, and heterosexuals with frequently changing sexual partners. However, here it must be noted that patterns of behaviour have changed over time and now differ with respect to different regions. Moreover, it appears that in Croatia, despite the 1991-1995 war events and other economical difficulties typical for a country in transition to a market economy, no greater increase in STIs cases has been registered. Unfortunately, it does not always necessarily reflect the real situation. As the example, the results of self-reported data of the national research in Croatia which has been conducted among populations in risk for STIs are presented. Men who have sex with men (N=214) reported history of STI as follows: syphilis 0.9%, gonorrhea 3.7%, genital herpes (GH) 0.4% and anal herpes (AH) 0%. Injecting drug users (N=291) reported syphilis in 0.3%, gonorrhea 1.7%, GH 1% and no reported AH. Migrant workers (N=460) reported syphilis in 0.2%, gonorrhea 2.2%, GH 0.4% and AH 0%. Commercial sex workers and their clients (N=350) reported syphilis 0.9%, gonorrhea 6%, GH 1.7% and no case of AH. And finally, persons that had more than 2 sexual partners in the last 12 months reported syphilis in 1.5%, gonorrhea 4.9%, GH 1.5% and AH 0.2%. Besides, the fact that every fifth sexually active 15-year-old in Croatia has sex without a condom or other contraceptive characterizes the same sexual experiences as very risky, and demands an appropriate intervention of the whole society. Some 700-900 chlamydial infections are registered annually. Compared to the year 2000 (773 cases), STIs cases caused by Chlamydia trachomatis in 2006 grew gradually (966 cases). A clear increase in the incidence of diseases caused by Chlamydia trachomatis after 2000 (ca. 100-300 diseased before 2000), as well as remaining proportionally high in the last years are the result of a partially improved STD monitoring and capacities, as well as of greater application of diagnostic procedures and early detection of asymptomatic carriers of the same bacterium. One should bare in mind, however, that here underreporting is common, which is why reported incidence data do not reflect the actual numbers of new cases but reflect trends over time. Regarding the HPV-genital infections the expected medical impact of the HPV vaccine to the STIs strategy in Croatia would be: up to 5 years: lowering the incidence of condylomata (anogenital warts) ; up to 5 – 10 years: lowering the incidence of CIN1, CIN2, and up to 10-20 years: lowering the incidence of cervical, vaginal, vulvar and anal cancer. It can be thus stated that newly developed HPV vaccines may substantially decrease public STIs clinic workloads with little associated lost opportunity to diagnose and treat other STIs. In general, it can be concluded that it is definitely necessary to know the real level of the problem in order to be able to organize appropriate treatment and management of STIs.

STIs; surveillance; HPV

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