Individual-level approaches such as condom promotion and behaviour change to combat sexually transmitted infections (STIs) should be enhanced by a population-wide approach, experts say.
In a Monash University-led paper in eClinicalMedicine, international research and policy leaders said this should encompass improved education campaigns, greater accessibility to sexual health services, better protecting susceptible communities through vaccination and enhanced preventive and post-exposure treatments.
The new approach call comes as STI rates rise globally. "With over 374 million new curable bacterial STI cases annually, we are far from meeting global health targets," the experts from Australia, Sweden, England, France, Brazil, South Africa and the World Health Organization (WHO) wrote.
"Despite their serious consequences for sexual, reproductive, and mental health, control efforts often focus on individual-level interventions like condom promotion and behaviour change, which are insufficient.
"A scientific framework for STI control emphasises reducing infectiousness, decreasing the number of susceptible individuals, and lowering transmission probability. Effective strategies should focus on environmental modifications, including expanding access to quality sexual health care, rapid testing with same-visit treatment, and AI-enhanced diagnostics."
The WHO estimated 374 million new cases of four curable bacterial STIs globally in 2020: syphilis, gonorrhoea, chlamydia and trichomoniasis. By 2030, it aims to reduce that to less than 150 million.
First author and Monash University Professor Jason Ong, who is director of Alfred Health's Melbourne Sexual Health Centre, said the control of STIs, particularly bacterial STIs, had received little attention globally from health departments and policy-makers, despite their long-term health consequences.
Professor Ong said shifting the narrative of STI control from poor personal choices that play a relatively small role to improving health care access may help.
He said the COVID-19 pandemic greatly improved understanding about infectious disease transmission in the community, enabling STIs to be framed within basic disease epidemiology.
"Behavioural interventions like condom promotion are still relevant, but falling usage could affect their impact," Professor Ong said. "STI and antimicrobial resistance surveillance is essential, as they involve all the key drivers of transmission.
"To control STIs more effectively, we need systems-level public health strategies. This includes prioritising accessible, stigma-free health services, incorporating new technology, and investing in comprehensive STI prevention public health policies."
Senior Author and Monash University public health Professor Christopher Fairley said the focus should be on system-level changes that shape the environment in which people lived, rather than solely relying on changing individual behaviours.
"A comprehensive STI intervention must address stigma through community-led education campaigns, and integrate STI services into general healthcare settings to enhance the uptake of interventions such as post-exposure treatments and vaccination," he said.
The paper's authors are from Monash University's School of Translational Medicine, Melbourne Sexual Health Centre, Alfred Health, WHO Collaborating Centre for Gonorrhoea and Other STIs, Sweden's Örebro University, University College London, the University of Paris, Brazil's University of Espirito Santo, Griffith University, WHO Global HIV, Hepatitis and STIs programs, and South Africa's University of Witwatersrand.
