We review some aspects of the epidemiology of sexually transmitted diseases (STDs) in the developing countries of Africa and Latin America. Apart from their elevated prevalence, they are responsible for important morbidity in mother and child. Stillbirth, premature delivery, conjunctivitis, and respiratory tract morbidity of the neonate are frequently caused by STDs. Sequelae in adult women include pelvic inflammatory disease, ectopic pregnancy, and infertility. The emergence of antimicrobial resistance has complicated the picture in recent times. Genital ulcer disease is very common in developing countries, the most important being chancroid. Both continents are experiencing major epidemics of the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection with different epidemiological characteristics than in the industrialized world. A link might exist between the high prevalence of STDs and the rapid heterosexual spread of HIV infection.
PIP: Aspects of sexually transmitted diseases (STDS) peculiar to the developing countries in South America and sub-Saharan Africa are discussed. The most common STD infections are N. Gonorrhoeae, Chlamydia trachomatis, T. pallidum and T. vaginalis. Vertical transmission, particularly of syphilis among prostitutes, and of Chlamydia and gonorrhea after ophthalmia neonatorum, are common. Chlamydia is also a common respiratory tract infection in African neonates. Late complications of STDs, infertility and ectopic pregnancy, and particularly pelvic inflammatory disease, are responsible for a high proportion of hospitalizations. Antibiotic resistant gonorrhea strains are common, a result of poorly managed antibiotic treatment. Genital ulcer diseases (GUD), which predispose to HIV infections, are more common in Africa than in developed countries, not only herpes but chancroid, donovanosis and lymphogranuloma venereum. Chancroid, caused by Haemophilus ducreyi, causes 36-49% of ulcers in 2 reports. The L1-L3 strains of Chlamydia trachomatis cause lymphogranuloma venereum, the agent responsible for ulcers in 3.6-6.1% of 2 clinic populations. HIV infections have an equal sex ratio in Africa, with a younger age incidence in women and a high vertical transmission rate, while in Latin America, bisexual men, and increasingly, heterosexual transmission by intravenous drug users is reported. There is also an HIV-2 virus, whose virulence is in question, common in West Africa.