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How can we prevent sexually transmitted infections and hiv/aids

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Major interval developments include 1 licensure and uptake of immunization against genital human papillomavirus, 2 validation of male circumcision as a potent prevention tool against acquisition of HIV and some other sexually transmitted infections STIs3 failure of a promising HIV vaccine candidate to afford protection against HIV acquisition, 4 encouragement about the use of antiretroviral agents as preexposure prophylaxis to reduce risk of HIV and herpes simplex virus acquisition, 5 enhanced emphasis on expedited partner management and rescreening for persons infected with Chlamydia trachomatis and Neisseria gonorrhoeae6 recognition that behavioral interventions will be needed to address a new trend of sexually transmitted hepatitis C among men who have sex with men, and 7 the availability of a modified female condom.

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A range of preventive interventions is needed to reduce the risks of acquiring STI, including HIV infection, among sexually active people, and a flexible approach targeted to specific populations should integrate combinations of biomedical, behavioral, and structural interventions.

These would ideally involve an array of prevention contexts, including 1 communications and practices among sexual partners, 2 transactions between individual clients and their healthcare providers, and 3 comprehensive population-level strategies for prioritizing prevention research, ensuring accurate outcome assessment, and formulating health policy.

Major interval developments include 1 licensure and uptake of immunization against genital human papillomavirus HPV2 validation of male circumcision as a potent prevention tool against acquisition of HIV and some STIs, 3 failure of a promising HIV vaccine candidate to afford protection against HIV acquisition, 4 encouragement about the use How can we prevent sexually transmitted infections and hiv/aids antiretroviral agents as both early treatment for HIV-positive persons and preexposure prophylaxis for HIV-negative persons to reduce the risk of HIV and herpes simplex virus HSV acquisition, 5 enhanced emphasis on expedited partner management and rescreening for persons infected with Chlamydia trachomatis or Neisseria gonorrhoeae6 recognition that behavioral interventions will be needed to address a new trend of sexually transmitted hepatitis C among "How can we prevent sexually transmitted infections and hiv/aids" who have sex with men MSMand 7 the availability of a modified female condom.

The need for effective prevention of HIV and other STIs remains a high priority, both internationally and domestically. Moreover, a large proportion of new HIV infections continue to be diagnosed in late stages of the disease [ 45 ]. Inthe number of reported cases of gonorrhea remained stable, with increasing concern about advancing antimicrobial resistance, and cases of primary and secondary syphilis comprised the highest number of cases reported since [ 6 ].

Some data suggest that an epidemiologic shift of the syphilis resurgence into heterosexual networks may be underway [ 9 ]. Finally, sexual transmission of hepatitis C is increasingly recognized in MSM who reported sexual practices involving exposure to blood or even minimal trauma to the rectal mucosa [ 10—12 ]. We have not included community-level behavioral interventions, because these have been extensively reviewed elsewhere [ 13 ]. We used the following MeSH terms: We considered their data if the abstracts had not yet resulted in published articles.

Abstract authors were contacted for more information if necessary. Key questions were generated by review of these resources and in consultation with experts in the fields of infectious diseases and prevention. We emphasize randomized controlled trials in our review, but methodologically sound observational cohort and cross-sectional studies were also included when data on a particular topic were sparse.

Preexposure vaccination is one of the most effective methods for preventing transmission of 2 main STDs: HPV infection and hepatitis B Table 1. In published clinical trials, the quadrivalent HPV vaccine has demonstrated efficacy for prevention of vaccine HPV type-related cervical, vaginal, and vulvar cancer precursor and dysplastic lesions, and external genital warts [ 15 ].

Universal vaccination of girls aged 11—12 years is recommended, as is catch-up vaccination for girls and women aged 13—26 years. The vaccine is also efficacious in preventing infection in women aged 24—45 years not already infected with the relevant HPV types. Both men and women are also likely to benefit from protection against anal intraepithelial neoplasia afforded by the quadrivalent vaccine.

Immunization against hepatitis B has been routinely recommended for infants since and was subsequently recommended for adolescents. Although this has been temporally associated with marked declines in the incidence of hepatitis B virus infection in the United States [ 21 ], sexual transmission still accounts for the majority of new infections, which are especially common among unvaccinated MSM.

Consequently, hepatitis B vaccination is recommended for all adults who are at risk for sexual infection, including sex partners of persons positive for hepatitis B surface antigen, sexually active persons who are not in a long-term, mutually monogamous relationship, persons seeking evaluation or treatment for a STD, and MSM [ 22 ].

Moreover, all HIV-infected persons should be immunized against hepatitis B, because the natural history of hepatitis B is accelerated in the setting of HIV, and coinfection imposes specific considerations in selection of antiretroviral agents. Hepatitis A vaccine is licensed and is recommended for MSM and illicit drug users both injecting and noninjecting [ 23 ] details available at http: Prospects for an effective HIV vaccine remain on the distant horizon.

Recent disappointing results from human trials have stimulated a renewed focus on the basic biology of HIV pathogenesis. Two phase III trials of a vaccine aimed at eliciting neutralizing antibodies against the envelope glycoprotein did not find protection against HIV infection [ 2526 ]. Interim analysis revealed no protective effect against HIV acquisition and no reduction in initial viral loads among participants infected with HIV [ 2728 ].

Further analysis showed that preexisting immunity to adenovirus type 5 was directly associated with a significantly higher risk of acquiring HIV and that this untoward effect was further augmented among uncircumcised men.

There was a trend toward prevention of HIV infection in the intention-to-treat analysis vaccine efficacy, The STD Treatment Guidelines noted that, when used consistently and correctly, male latex condoms are effective in preventing sexual transmission of HIV and other STDs, including chlamydia, gonorrhea, syphilis, genital HPV, and trichomoniasis [ 1 ].

By limiting lower genital tract infections, male condoms might also reduce the risk of pelvic inflammatory disease in women [ 30 ]. How can we prevent sexually transmitted infections and hiv/aids use might also reduce the risk for transmission of HSV-2, although data for this effect are more limited [ 3233 ]. Finally, condom use reduces the risk of HPV infection [ 3435 ] and HPV-associated diseases eg, genital warts and cervical cancer [ 36 ].

Use of condoms has been associated with regression of cervical intraepithelial neoplasia [ 37 ] and clearance of HPV infection in women, and with regression of HPV-associated penile lesions in men [ 38 ].

Sinceavailable data on male condom efficacy have emerged in several areas: Investigators followed up 82 female university students who reported their first intercourse with a male partner either during the study period or within 2 weeks before enrollment [ 35 ]. The incidence of genital HPV infection was In a separate cross-sectional study from 2 cities in the United States, men were assessed for 37 HPV types from 5 anogenital sites.

Prospective studies continue to support a protective effect of condoms against acquisition of genital herpes, chlamydia, and gonorrhea.

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